CAJ | 학술논문

目的了解我国AIDS患者肺部感染的病原体分布及耐药情况.方法分析116例AIDS患者经纤维支气管镜病原学和(或)病理学确诊的肺部感染的病原体及药物敏感试验结果.结果肺部单一病原感染18例(15.5%),多重感染98例(84.5%).病原体分布:细菌91例,真菌62例,结核分枝杆菌49例,肺孢子菌29例,巨细胞病毒11例.共分离出细菌95株,以链球菌属(34株)、凝固酶阴性葡萄球菌(20株)、肺炎克雷伯杆菌(10株)及大肠埃希菌(7株)为主,存在对β-内酰胺类、大环内酯类、喹诺酮类和氨基糖苷类药物多重耐药,耐甲氧西林葡萄球菌14株,产超广谱β-内酰胺酶菌12株.分离出真菌68株,包括假丝酵母菌36株,青霉菌19株,曲霉菌6株,毛霉菌5株及其他2株.对两性霉素B敏感,对氟康唑耐药率5.6%～50.0%,对伊曲康唑耐药率10.5%～60.0%.结论本组AIDS患者肺部感染常同时存在多种病原,以细菌与真菌为主,呈现多重耐药现象,应根据药敏试验选择抗菌药物.
목적 료해아국AIDS환자폐부감염적병원체분포급내약정황.방법 분석116례AIDS환자경섬유지기관경병원학화(혹)병이학학진적폐부감염적병원체급약물민감시험결과.결과 폐부단일병원감염18례(15.5%),다중감염98례(84.5%).병원체분포:세균91례,진균62례,결핵분지간균49례,폐포자균29례,거세포병독11례.공분리출세균95주,이련구균속(34주)、응고매음성포도구균(20주)、폐염극뢰백간균(10주)급대장애희균(7주)위주,존재대β-내선알류、대배내지류、규낙동류화안기당감류약물다중내약,내갑양서림포도구균14주,산초엄보β-내선알매균12주.분리출진균68주,포괄가사효모균36주,청매균19주,곡매균6주,모매균5주급기타2주.대량성매소B민감,대불강서내약솔5.6%～50.0%,대이곡강서내약솔10.5%～60.0%.결론 본조AIDS환자폐부감염상동시존재다충병원,이세균여진균위주,정현다중내약현상,응근거약민시험선택항균약물.
Objective To study the pathogens and drug resistance profiles of pulmonary infection in patients with AIDS. Methods The pathogens and their drug susceptibility of pulmonary infection diagnosed by fibrobronchescopy-induced brunchoalveolar lavage fluid (BAI.F) culture and/or transbronchial biopsy in 116 AIDS cases were analyzed. Results Monopathogenic infection in lungs were detected in 18 cases(15.5%) and mixed infection in 98 cases ( 84.5%). Of the 116 cases, bacteria were present in 91 patients, fungi in 62, tubercle bacillus in 49, pneumocystis jiroveci in 29, and cytomegalovirus in 11.Ninety-five bacterial strains were isolated from BALF, mainly including Streptococci (34), coagulase negative Staphylococcus (20), Klebsiella pneumoniae (10) and Escherichia (7). The isolated bacteria were resistant to β-lactam, macrolides, quinolones and aminoglycosides, of which were 14 methicillin-resistant Streptococci (MRS) strains and 12 extended spectrum β-lactamases (ESBL) strains. Sixty-eight fungal strains were isolated, including 36 Candida mycodermas, 19 Penicilliums, 6 Aspergilli and 5 Mold fungi;they were sensitive to amphotericin B but resistant to fluconazol (5.6% -50. 0% ) and itraconazole( 10. 5%-60. 0% ). Conclusion Pneumonia in AIDS patients are usually caused by multiple pathogens,predominantly consisting of multiresistant bacteria and fungi. Therefore, antibiotics should be rationally chosen according to drug susceptibility test.