黏质沙雷菌致肺结核患者感染的相关危险因素与耐药性研究
|
摘要
目的探讨黏质沙雷菌致肺结核患者感染的相关危险因素、产β-内酰胺酶情况和耐药性,为临床合理用药提供依据。方法选取确诊的肺结核合并黏质沙雷菌感染患者为观察组,同期确诊的单纯肺结核患者为对照组,分析感染的危险因素,采用WHONET 5.6软件分析药敏试验结果。结果使用广谱抗菌药物、应用糖皮质激素、进行侵入性诊疗等均是引起肺结核合并黏质沙雷菌感染的危险因素;该菌在痰液标本中检出率最高,占84.9%;产ESBLs率为32.1%,产AmpC酶率为26.4%,同时产ESBLs和AmpC酶菌占9.4%,产碳青霉烯酶率为5.7%;药敏试验表明该菌对临床多数常用抗菌药物出现不同程度的耐药,其中对头孢唑林、头孢呋辛100.0%耐药。结论尽量减少侵入性操作,合理使用抗菌药物,积极治疗原发病,有利于预防肺结核合并黏质沙雷菌感染。该菌多重耐药现象较为严重,耐药性的产生与产ESBLs、AmpC酶和碳青霉烯酶有关。
Objective To investigate the risk factors, β-lactamase production, and drug resistance of pulmonary tuberculosis caused by Serratia marcescens, so as to provide basis for clinically rational selection of antimicrobial drugs. Methods The hospitalized patients with tuberculosis and Serratia marcescens infection were selected as the observation group, hospitalized patients with simple pulmonary tuberculosis in the same period were selected as control group, the risk factors for infection was analyzed, and WHONET 5.6 software was used to analyze drug sensitivity test results. Results Use of broad-spectrum antibiotics, use of glucocorticoids, invasive treatment were all risk factors for pulmonary tuberculosis infection with serratia marcescens infection; Serratia marcescens had the highest detection rate in sputum samples, accounting for 84.9%; the producing rate of ESBLs was 32.1%, the production rate of AmpC enzyme was 26.4%, ESBLs and AmpC producing bacteria accounted for 9.4%, and the rate of carbapenemase production was 5.7%; drug susceptibility test showed that Serratia marcescens showed different degrees of resistance to most clinically used antimicrobial agents, among which 100.0% were resistant to cefazolin and cefuroxime. Conclusion Minimizing invasive operations, rational use of antibiotics, and active treatment of the primary disease were beneficial to the prevention of pulmonary tuberculosis in patients infected with Serratia marcescens. The multidrug resistance of Serratia marcescens was more serious, and the production of drug resistance was related to the production of ESBLs, AmpC enzymes and carbapenemase.
Objective To investigate the risk factors, β-lactamase production, and drug resistance of pulmonary tuberculosis caused by Serratia marcescens, so as to provide basis for clinically rational selection of antimicrobial drugs. Methods The hospitalized patients with tuberculosis and Serratia marcescens infection were selected as the observation group, hospitalized patients with simple pulmonary tuberculosis in the same period were selected as control group, the risk factors for infection was analyzed, and WHONET 5.6 software was used to analyze drug sensitivity test results. Results Use of broad-spectrum antibiotics, use of glucocorticoids, invasive treatment were all risk factors for pulmonary tuberculosis infection with serratia marcescens infection; Serratia marcescens had the highest detection rate in sputum samples, accounting for 84.9%; the producing rate of ESBLs was 32.1%, the production rate of AmpC enzyme was 26.4%, ESBLs and AmpC producing bacteria accounted for 9.4%, and the rate of carbapenemase production was 5.7%; drug susceptibility test showed that Serratia marcescens showed different degrees of resistance to most clinically used antimicrobial agents, among which 100.0% were resistant to cefazolin and cefuroxime. Conclusion Minimizing invasive operations, rational use of antibiotics, and active treatment of the primary disease were beneficial to the prevention of pulmonary tuberculosis in patients infected with Serratia marcescens. The multidrug resistance of Serratia marcescens was more serious, and the production of drug resistance was related to the production of ESBLs, AmpC enzymes and carbapenemase.
引文
[1] 陈蕾. 肺结核并发下呼吸道感染易感因素分析[J]. 结核病与肺部健康杂志, 2016, 5(3): 233-236.
[2] 陈炜, 甄国东, 赵琼, 等. 引发重症监护室内血流感染的粘质沙雷菌同源性分析[J]. 中华微生物学和免疫学杂志, 2015, 35(3): 183-187.
[3] 杨海飞, 程君, 胡立芬, 等. 粘质沙雷菌中AmpC酶的检测及药敏率分析[J]. 安徽医学, 2012, 33(2): 129-132.
[4] 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 81(5): 314-320.
[5] 尚红, 王毓三, 申子瑜. 全国临床检验操作规程[S]. 北京: 人民卫生出版社, 2015: 702-703.
[6] CLSI. Performance standards for antimicrobial susceptibility testing: twenty-fourth informational supplement. CLSI document M100-S24[S]. Wayne, PA: Clinical and Laboratory Standards Institute, 2014.
[7] 张志祥, 吴文汉. 56株粘质沙雷菌的分布及其耐药性分析[J]. 中国消毒学杂志, 2013, 30(12): 1134-1137.
[8] 轩杰, 刘秀芳, 陈远乡, 等. 医院内粘质沙雷菌肺部感染的危险因素及药敏分析[J]. 中国消毒学杂志, 2015, 32(11): 1146-1147.
[9] 刘晓燕, 王坚杰, 张正斌, 等. 肺结核并发真菌感染133例的临床特点及耐药性分析[J]. 中国医药导刊, 2014, 16(2): 317-318.
[10] 马艳萍. 肺结核患者肺部感染相关危险因素分析及临床护理研究[J]. 国际护理学杂志, 2017, 36(6): 844-846.
[11] 段鸿飞, 初乃惠. 糖尿病合并肺结核的研究进展[J]. 北京医学, 2013, 35(9): 802-803.
[12] 吴建荣, 鲍千红, 徐公民. 某医院粘质沙雷菌感染的临床分布及耐药性分析[J]. 中国消毒学杂志, 2016, 33(4): 341-345.
[13] 陈炜, 甄国东, 赵琼, 等. 引发重症监护室内血流感染的粘质沙雷菌同源性分析[J]. 中华微生物学和免疫学杂志, 2015, 35(3): 183-187.
[14] 冯胜春, 徐浩, 陈建飞. 肺结核患者感染产β-内酰胺酶粘质沙雷菌及其耐药性研究[J]. 中国消毒学杂志, 2015, 32(5): 455-457.
[15] 王彩莲, 刘丽梅. 肺结核并发粘质沙雷菌肺部感染的耐药性分析及产ESBLs、AmpC酶和碳青霉烯酶的检测[J]. 中国微生态学杂志, 2016, 28(9): 1087-1093.
[16] 谢在海, 朱元祺, 李莉, 等. 粘质沙雷菌β-内酰胺类耐药基因研究[J]. 中国实验诊断学, 2014, 18(3): 431-434.
[17] 邹安庆, 费静娴, 吴莲凤, 等. 粘质沙雷菌对碳青霉烯类抗生素的耐药性研究[J]. 中国抗生素杂志, 2013, 38(1): 59-62.
[2] 陈炜, 甄国东, 赵琼, 等. 引发重症监护室内血流感染的粘质沙雷菌同源性分析[J]. 中华微生物学和免疫学杂志, 2015, 35(3): 183-187.
[3] 杨海飞, 程君, 胡立芬, 等. 粘质沙雷菌中AmpC酶的检测及药敏率分析[J]. 安徽医学, 2012, 33(2): 129-132.
[4] 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 81(5): 314-320.
[5] 尚红, 王毓三, 申子瑜. 全国临床检验操作规程[S]. 北京: 人民卫生出版社, 2015: 702-703.
[6] CLSI. Performance standards for antimicrobial susceptibility testing: twenty-fourth informational supplement. CLSI document M100-S24[S]. Wayne, PA: Clinical and Laboratory Standards Institute, 2014.
[7] 张志祥, 吴文汉. 56株粘质沙雷菌的分布及其耐药性分析[J]. 中国消毒学杂志, 2013, 30(12): 1134-1137.
[8] 轩杰, 刘秀芳, 陈远乡, 等. 医院内粘质沙雷菌肺部感染的危险因素及药敏分析[J]. 中国消毒学杂志, 2015, 32(11): 1146-1147.
[9] 刘晓燕, 王坚杰, 张正斌, 等. 肺结核并发真菌感染133例的临床特点及耐药性分析[J]. 中国医药导刊, 2014, 16(2): 317-318.
[10] 马艳萍. 肺结核患者肺部感染相关危险因素分析及临床护理研究[J]. 国际护理学杂志, 2017, 36(6): 844-846.
[11] 段鸿飞, 初乃惠. 糖尿病合并肺结核的研究进展[J]. 北京医学, 2013, 35(9): 802-803.
[12] 吴建荣, 鲍千红, 徐公民. 某医院粘质沙雷菌感染的临床分布及耐药性分析[J]. 中国消毒学杂志, 2016, 33(4): 341-345.
[13] 陈炜, 甄国东, 赵琼, 等. 引发重症监护室内血流感染的粘质沙雷菌同源性分析[J]. 中华微生物学和免疫学杂志, 2015, 35(3): 183-187.
[14] 冯胜春, 徐浩, 陈建飞. 肺结核患者感染产β-内酰胺酶粘质沙雷菌及其耐药性研究[J]. 中国消毒学杂志, 2015, 32(5): 455-457.
[15] 王彩莲, 刘丽梅. 肺结核并发粘质沙雷菌肺部感染的耐药性分析及产ESBLs、AmpC酶和碳青霉烯酶的检测[J]. 中国微生态学杂志, 2016, 28(9): 1087-1093.
[16] 谢在海, 朱元祺, 李莉, 等. 粘质沙雷菌β-内酰胺类耐药基因研究[J]. 中国实验诊断学, 2014, 18(3): 431-434.
[17] 邹安庆, 费静娴, 吴莲凤, 等. 粘质沙雷菌对碳青霉烯类抗生素的耐药性研究[J]. 中国抗生素杂志, 2013, 38(1): 59-62.