艾滋病合并呼吸道感染患者的病原菌分布及药敏分析
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摘要
目的了解我院艾滋病合并呼吸道感染患者的病原菌分布及药敏情况,为临床治疗艾滋病合并呼吸道感染患者提供依据。方法收集2015年至2017年北京地坛医院住院的艾滋病合并呼吸道感染患者的合格痰液及支气管肺泡灌洗液(BALF)的细菌培养和药敏结果 ,回顾性分析病原菌的分离情况,采用Whonet 5.6软件对细菌进行药物敏感性分析。结果共检验1239例艾滋病合并呼吸道感染患者的合格痰液及肺泡灌洗液标本,去除同一患者的重复培养结果后,共培养阳性135例(痰液93例,肺泡灌洗液42例),阳性率10.89%。包括细菌121例(89.6%),酵母菌11例(8.1%)和双相真菌3例(2.2%)。其中细菌包括结核分枝杆菌31例(22.9%),非结核分支杆菌16例(11. 85%),革兰氏阴性菌58例(43.0%),革兰式阳性菌16例(11.9%)。革兰氏阴性菌中排名前五位的是铜绿假单胞菌(11例),大肠埃希氏菌(10例),肺炎克雷伯菌(8例),鲍曼不动杆菌(7例),阴沟肠杆菌(6例)。大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率为0,但对氨苄西林的耐药率分别是100%和62.5%,铜绿假单胞菌对亚胺培南的耐药率为44.4%。然而,7例鲍曼不动杆菌全部为泛耐药菌株,除对多粘菌素B敏感外,对所有抗菌药耐药。真菌对多种抗真菌药物敏感。结论艾滋病合并呼吸道感染病原菌主要以革兰氏阴性菌为主,并且耐药现象明显,尤其鲍曼不动杆菌的耐药应当引起极度重视。
Objective To understand the pathogen distribution and drug susceptibility of AIDS patients with respiratory infection in our hospital,and to provide a knowledge base for the clinical treatment of AIDS patients with respiratory infection. Methods We collected qualified sputum and bronchoalveolar lavage fluid(BALF)from patients with AIDS-associated respiratory infections in Beijing Ditan Hospital from 2015 to 2017. We retrospectively analyzed and classified the pathogens, and used Whonet 5. 6 software to perform the drug susceptibility analysis. Results A total of I,239 samples of qualified sputum and bronchoalveolar lavage fluid from AIDS patients associated with respiratory infections were collected for the study. After removing duplicate culture results from the same patient, 135 positive cases were cultured(93 sputum and 42 bronchoalveolar lavage fluids). The positive rate was 10. 89%. It mainly included 121 cases bacteria(89.6%),11 cases yeast(8.1%),and 3 cases bidirectional fungus(2. 2%). Among them, there were 31 cases(22. 9%) Mycobacterium tuberculosis, 16 cases( 11.8%)Nontuberculosis mycobacteria,58 cases(43. 0%)of gram-negative bacteria and16 cases(11.9%)of gram-positive bacteria. The top five gram-negative bacteria were Pseudomonas aeruginosa(11 cases), E. coli(10 cases), Klebsiella pneumoniae(8 cases), Acinetobacter baumannii(7 cases), and Enterobacter cloacae(6 cases). The resistance rates of E. coli and K. pneumoniae to imipenem were 0,but the resistance rates to ampicillin were 100% and 62. 5%, respectively. The resistance rate of P. aeruginosa to imipenem was 44.4%. However,7 cases of Acinetobacter baumannii were all pan-drug-resistant strains,and they were resistant to all antibiotics except for polymyxin B. Fungi were sensitive to various antifungal drugs.Conclusion Gram-negative bacteria are the main pathogens of AIDS patients with respiratory tract infections.The phenomenon of drug resistance is significant and the drug resistance of Acinetobacter baumannii should be given a great attention in the clinical practice.
Objective To understand the pathogen distribution and drug susceptibility of AIDS patients with respiratory infection in our hospital,and to provide a knowledge base for the clinical treatment of AIDS patients with respiratory infection. Methods We collected qualified sputum and bronchoalveolar lavage fluid(BALF)from patients with AIDS-associated respiratory infections in Beijing Ditan Hospital from 2015 to 2017. We retrospectively analyzed and classified the pathogens, and used Whonet 5. 6 software to perform the drug susceptibility analysis. Results A total of I,239 samples of qualified sputum and bronchoalveolar lavage fluid from AIDS patients associated with respiratory infections were collected for the study. After removing duplicate culture results from the same patient, 135 positive cases were cultured(93 sputum and 42 bronchoalveolar lavage fluids). The positive rate was 10. 89%. It mainly included 121 cases bacteria(89.6%),11 cases yeast(8.1%),and 3 cases bidirectional fungus(2. 2%). Among them, there were 31 cases(22. 9%) Mycobacterium tuberculosis, 16 cases( 11.8%)Nontuberculosis mycobacteria,58 cases(43. 0%)of gram-negative bacteria and16 cases(11.9%)of gram-positive bacteria. The top five gram-negative bacteria were Pseudomonas aeruginosa(11 cases), E. coli(10 cases), Klebsiella pneumoniae(8 cases), Acinetobacter baumannii(7 cases), and Enterobacter cloacae(6 cases). The resistance rates of E. coli and K. pneumoniae to imipenem were 0,but the resistance rates to ampicillin were 100% and 62. 5%, respectively. The resistance rate of P. aeruginosa to imipenem was 44.4%. However,7 cases of Acinetobacter baumannii were all pan-drug-resistant strains,and they were resistant to all antibiotics except for polymyxin B. Fungi were sensitive to various antifungal drugs.Conclusion Gram-negative bacteria are the main pathogens of AIDS patients with respiratory tract infections.The phenomenon of drug resistance is significant and the drug resistance of Acinetobacter baumannii should be given a great attention in the clinical practice.
引文
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[8]王印,朱迎春,周锐峰,等.HIV/AIDS合并结核病患者196株结核分枝杆菌耐药分析[J].重庆医学,2017,46(9):1203-1205.
[9]银春莲,谢周华,裴洁,等.HIV/AIDS合并非结核分枝杆菌肺病97例临床分析[J].传染病信息,2015,28(2):112-114.
[10]MOR S M,ASCOLILLO L R, NAKATO R, et al. Expectoration of cryptosporidium parasites in sputum of human immunodeficiency virus-positive and-negative adults[J]. Am J Trop Med Hyg,2018,98(4):1086-1090.
[2]叶应妩,王毓三,申子瑜.全国临床检验操作规程[M].第3版.南京:东南大学出版社,2006,715-920.
[3]刘利容,刘民.北京地区的AIDS流行病学研究[J].中国艾滋病性病,2006,12(2):189-191.
[4]魏艳艳,邹桂舟,叶珺,等.艾滋病合并机会性感染104例临床分析[J].安徽医药,2016,20(4):679-682.
[5]GUTIERREZ S,MORILLA R,LEON J A,et al. High prevalence of pneumocystis jiroveci colonization among young HIV-Ⅰinfected patients[J]. J Adolesc Health,2010,48(1):103-105.
[6]汪习成,黄晓婕,张彤,等. HIV/AIDS患者机会性感染特点分析[J].中华内科杂志,2007,46(5):379-382.
[7]曾静,刘雪梅,画伟,等.艾滋病肺部机会性感染[J].中国医药导报,2018,15(4):31-34.
[8]王印,朱迎春,周锐峰,等.HIV/AIDS合并结核病患者196株结核分枝杆菌耐药分析[J].重庆医学,2017,46(9):1203-1205.
[9]银春莲,谢周华,裴洁,等.HIV/AIDS合并非结核分枝杆菌肺病97例临床分析[J].传染病信息,2015,28(2):112-114.
[10]MOR S M,ASCOLILLO L R, NAKATO R, et al. Expectoration of cryptosporidium parasites in sputum of human immunodeficiency virus-positive and-negative adults[J]. Am J Trop Med Hyg,2018,98(4):1086-1090.