王彤 向华国 林玉平

[摘要]目的 探讨2型糖尿病合并下呼吸道感染的菌群特点。方法 选取我院2015年1月～2017年12月收治的120例2型糖尿病合并下呼吸道感染患者，采用美国Microscan Autoscan-4微生物分析仪对这些患者痰液中分离得到的398株菌株作鉴定及药敏试验。结果 120例患者共有100例患者细菌培养为阳性，阳性率为83.33%（100/120）；100例细菌培养阳性患者痰液标本共获得398株菌株，其中，革兰阴性菌株367株，占比92.21%，革兰阳性菌株31株，占比7.79%。嗜麦芽寡养单胞菌对亚胺培南天然耐药，其他4种革兰阴性菌对亚胺培南的耐药率为2.33%～15.3%。产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌（MRSA）、多重耐药铜绿假单胞菌（MDR-PA）和多重耐鲍曼不动杆菌（MDR-AB）的检出率分别为32.23 %、66.67%、25.51%、20.00%。结论 2型糖尿病合并下呼吸道感染患者痰液的细菌以革兰阴性菌为主，且细菌的耐药性高，在治疗过程中应选择合适的抗生素。

[关键词]2型糖尿病；下呼吸道感染；菌群分析；临床特点

[中图分类号] R781.6+4 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0050-04

[Abstract] Objective To explore the flora characteristics of type 2 diabetes mellitus combined with lower respiratory tract infection. Methods A total of 120 patients with type 2 diabetes mellitus complicated with lower respiratory tract infection treated in our hospital from January 2015 to December 2017 were selected， and the identification and drug sensitivity test in 398 strains isolated from sputum of these patients were conducted using a Microscan Autoscan-4 microbiological analyzer. Results A total of 100 patients in 120 patients were positive in bacterial culture， and the positive rate of 83.33% （100/120）. A total of 398 strains were isolated from sputum samples in 100 patients with positive bacterial culture， among them， 367 strains were Gram-negative strains （accounting for 92.21%）， and 31 strains were Gram-positive strains （ accounting for 7.79%）. Stenotrophomonas maltophilia was naturally resistant to Imipenem. The resistance rate of the other 4 Gram-negative bacteria to Imipenem was 2.33%-15.3%. The detection rate of extended-spectrum beta-Lactamases （ESBLs） producing Escherichia coli， Klebsiella pneumoniae， methicillin-resistant Staphylococcus aureus （MRSA）， multidrug-resistant Pseudomonas aeruginosa （MDR-PA） and multidrug-resistant Acinetobacter baumannii （MDR-AB） was 32.23%， 66.67%， 25.51% and 20.00%， respectively. Conclusion The bacteria in sputum for patients with type 2 diabetes mellitus complicated with lower respiratory tract infection is mainly Gram-negative bacteria， and their resistance to antibiotics is high， and appropriate antibiotics should be selected in the course of treatment.

[Key words] Type 2 diabetes mellitus； Lower respiratory tract infection； Flora analysis； Clinical features

下呼吸道感染（lower respiratory tract infection，LRI）是指在醫院外或入院后48 h内发生的急性下呼吸道感染，该病以突发性强，老年、幼儿患者多发为主要特点[1]。国内外研究表明，LRI病原菌以肺炎链球菌、流感嗜血杆菌及支原体、军团菌等非典型病原体为主[2]。正常人口咽部常寄存有各种各样的细菌，但是其在正常人体免疫功能下处于非致病的平衡状态。相对于口咽部而言，远端气道基本无菌。2型糖尿病（T2DM）患者由于血糖的高水平状态，极易导致这种非致病平衡状态被打破，而导致下呼吸道感染。……