煤工尘肺结核患者肺部细菌感染及耐药性研究

研究淮南矿区煤工尘肺结核患者肺部产超广谱β-内酰胺酶细菌感染及其耐药情况.对从煤工尘肺结核肺部感染患者痰标本分离的132株革兰阴性杆菌进行ESBLs检测,并对产ESBLs细菌进行药物敏感性检测.共计检出产ESBLs细菌31株,占全部测试菌株的23.48%,其中主要包括肺炎克雷伯菌15株,大肠埃希菌13株.产ESBLs细菌对氨苄西林均高度耐药;对头孢噻肟、头孢他定等第三代头孢菌素类也高度耐药;而头孢西丁对产ESBLs肺炎克雷伯菌及大肠埃希菌有较强的抗菌效果,但产ESBLs铜绿假单孢菌和阴沟肠杆菌对头孢西丁的耐药率却高达100%;除铜绿假单胞菌外的产ESBLs细菌对亚胺培南的敏感率极高;奈替米星、阿米卡星及氧氟沙星、环丙沙星对产ESBLs细菌抗菌作用较弱.淮南矿区煤工尘肺结核患者肺部产ESBLs细菌感染以产ESBLs肺炎克雷伯菌和大肠埃希菌引起的肺部感染为主要要致病菌,亚胺培南可作为治疗产ESBLs细菌(铜绿假单胞菌除外)的首选药物,临床应采取措施以预防产ESBLs细菌肺部感染的发生.

Study on Evaluation of Bacilli Causing Pulmonary Infection and the Drug Resistance in Coal Pneumoconiosis with Tuberculosis

To study ESBLs -- producing Bacilli causing pulmonary infection and the drug resistance in cases of coal pneumoconiosis with tuberculosis in Huainan mineral district. 132 Gram-negative bacilli isolated from sputum samples of the patients suffering from pulmonary infection were detected for the presence of ESBLs, and the drug resistance assay was subsequently conducted to ESBLs - producing strains. 31 strains were found ESBLs positive, and the detectable rate was 23.48%, mainly including 15 K. pneumoniae and 13 E. coll. All ESBLs-producing bacilli showed high resistance to cefetaxime and ceftazidime as well as ampicillin, while cefoxitin showed powerful antibacterial activity to ESBLs- producing K. pneumoniae and E. toll, but ESBLs-producing P. aeruginosa and E. cloacae showed the drug resistance of 100% to cefoxitin. Imipenem was high effective to all ESBLs - producing bacilli except for P. aeruginosa, and Netilmiein, Amikacin, Ofloxacin and Ciprofloxacin had feeble antibacterial effect on ESBLs - producing bacilli. ESBLs-producing Bacilli, especially by ESBLs- producing K. pneumoniae and E. coli causing pulmonary infection are the main pathogens in cases of coal pneumoconiosis combined with tuberculosis in Huainan mineral district. Imipenem may be considered as the preferred drug to cope with ESBLs - producing bacilli except for P. aeruginosa. The necessary measures should be applied to preventing the occurrence of pulmonary infection caused by ESBLs-producing Bacilli.