奚少勇 磨立达 罗晓璐

【摘要】 目的：研究肺结核患者继发肺部感染铜绿假单胞菌的耐药性，从而指导临床用药。方法：收集南宁市第四人民医院2014年6月-2019年6月住院或门诊治疗的135例肺结核病例，采用半自动结核鑒定药敏系统和自动微生物鉴定仪，对135例痰液或灌洗液培养出结核分枝杆菌和铜绿假单胞菌肺结核患者进行铜绿假单胞菌药敏试验，分析不同患者的耐药性。结果：CD4+T淋巴细胞<500个/μL者与≥500个/μL者对阿米卡星、环丙沙星、庆大霉素、头孢他啶、头孢吡肟、妥布霉素、哌拉西林、哌拉西林/他唑巴坦的耐药率比较，差异均无统计学意义（P>0.05）;CD4+T淋巴细胞<500个/μL者与≥500个/μL者对氨曲南、美罗培南、左氧氟沙星的耐药率比较，差异均有统计学意义（P<0.05）。不同年龄和性别的患者对阿米卡星、氨曲南、环丙沙星、美罗培南、庆大霉素、头孢他啶、头孢吡肟、妥布霉素、左氧氟沙星、哌拉西林和哌拉西林/他唑巴坦的耐药率比较，差异均无统计学意义（P>0.05）。结论：肺结核患者继发肺部感染铜绿假单胞菌时，外周血CD4+T淋巴细胞<500个/μL的患者对氨曲南、美罗培南和左氧氟沙星的耐药率更高，临床用药应高度重视。

【关键词】 肺结核 肺部感染 铜绿假单胞菌 CD4+T淋巴细胞 耐药率

[Abstract] Objective： To study the drug resistance of pseudomonas aeruginosa secondary to pulmonary infection in patients with pulmonary tuberculosis， so as to guide clinical medication. Method： A total of 135 cases of tuberculosis treated in the Fourth People’s Hospital of Nanning from June 2014 to June 2019 were collected. The drug susceptibility test of pseudomonas aeruginosa in 135 tuberculosis patients with Mycobacterium tuberculosis and pseudomonas aeruginosa cultured in sputum or perfusion fluid was carried out by using semi-automatic tuberculosis drug susceptibility system and automatic microorganism identification instrument. The drug resistance of different patients was analyzed. Result： Comparison of the drug resistance rates of CD4+T lymphocytes < 500 /μL and ≥500 /μL to Amikacin， Ciprofloxacin， Gentamicin， Ceftazidime， Cefepime， Tobramycin， Piperacillin and Piperacillin/Tazobactam， there were no significant differences （P>0.05）. The drug resistance rates of CD4+T lymphocytes < 500 /μL and ≥500 /μL to Aztreonam， Meropenem and Levofloxacin were compared， the differences were statistically significant （P<0.05）. Comparison of drug resistance rates of Amikacin， Aztreonam， Ciprofloxacin， Meropenem， Gentamicin， Ceftazidime， Cefepime， Tobramycin， Levofloxacin， Piperacillin and Piperacillin/Tazobactam in patients of different ages and genders， there were no significant differences （P>0.05）. Conclusion： In pulmonary tuberculosis patients with secondary pulmonary infection of pseudomonas aeruginosa， patients with peripheral blood CD4+T lymphocytes <500/μL had higher drug resistance rates to Amtronam， Meropenem and Levofloxacin， which should be paid more attention to in clinical use.

[Key words] Tuberculosis Pulmonary infection Pseudomonas aeruginosa CD4+T lymphocytes Drug resistance rate

First-author’s address： Nanning Fourth People’s Hospital， Nanning 530023， China

doi：10.3969/j.issn.1674-4985.2021.25.038

铜绿假单胞菌（pseudomonas aeruginosa，PA）是假单胞菌属的代表菌种，是导致肺部感染的主要條件致病菌[1]，其广泛分布于土壤、水和空气中，常寄居于人体的皮肤，呼吸道及消化道等，为条件致病菌，也是医院感染的常见病原菌之一[2]。PA引起的感染往往治疗较为困难，且持续和反复[3]。……