某院晚期原发性肝癌化疗患者发生肺部感染的病原菌分布与耐药情况分析

Analysis of Distribution and Drug Resistance of Pathogenic Bacteria in Pulmonary Infection in Patients with APLC Undergoing Chemotherapy in a Hospital

目的:分析晚期原发性肝癌(advanced primary liver cancer,APLC)化疗患者发生肺部感染的病原菌分布与耐药情况,为该类患者的抗菌药物合理使用提供参考。方法:选取2019年6月—2021年6月济源市肿瘤医院收治的148例APLC化疗期间并发院内肺部感染患者作为研究对象,采集其痰液行病原菌培养与药敏试验,分析标本中病原菌的分布与耐药情况。结果:148例APLC患者痰液标本中共分离出172株病原菌,其中革兰阳性菌46株(占26.74%,以金黄色葡萄球菌、肺炎链球菌为主)、革兰阴性菌107株(占62.21%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌为主)和真菌19株(占11.05%);药敏结果显示,大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌对哌拉西林-舒巴坦钠和美罗培南的耐药率较低(<30.00%),对头孢唑林、头孢曲松、氨苄西林、庆大霉素的耐药率较高(>65.00%);金黄色葡萄球菌、肺炎链球菌对万古霉素、利奈唑胺的耐药率较低(<5.00%),对青霉素G、红霉素、阿米卡星和复方磺胺甲噁唑的耐药率较高(≥70.00%);白假丝酵母、热带假丝酵母、光滑假丝酵母对酮康唑的耐药率较低(<5.00%),对氟康唑、两性霉素B、5-氟胞嘧啶的耐药率较高(≥50.00%)。结论:APLC化疗患者院内肺部感染病原菌以革兰阴性菌为主,主要病原菌对大多数抗菌药物的耐药率均较高,临床应根据药敏结果选择敏感率高的抗菌药物治疗,以有效控制肺部感染。

Objective:To investigate the distribution and drug resistance of pathogenic bacteria in pulmonary infection in patients with advanced primary liver cancer(APLC)undergoing chemotherapy,so as to provide reference for the rational use of antibacterials in such patients.Methods:A total of 148 APLC patients who were admitted to Jiyuan Cancer Hospital from June 2019 to June 2021 and concurrently developed nosocomial pulmonary infection during the period of chemotherapy were selected as study subjects.The patients’sputum was collected for pathogenic bacteria culture and drug susceptibility test,and the distribution and drug resistance of pathogenic bacteria in the specimens were analyzed.Results:A total of 172 strains of pathogenic bacteria were isolated from the sputum specimens of 148 patients with APLC,including 46 strains of Gram-positive bacteria(26.74%,mainly Staphylococcus aureus and Streptococcus pneumoniae),107 strains of Gram-negative bacteria(62.21%,mainly Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii)and 19 strains of fungi(11.05%).The drug susceptibility test showed that the resistance rates of Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii to piperacillin-sulbactam sodium and meropenem were low(less than 30.00%),and their resistance rates to cefazolin,ceftriaxone,ampicillin and gentamicin were high(greater than 65.00%);the resistance rates of Staphylococcus aureus and Streptococcus pneumoniae to vancomycin and linezolid were low(less than 5.00%),and their resistance rates to penicillin G,erythromycin,amikacin and trimethoprim sulfamethoxazole were high(greater than or equal to70.00%);the resistance rates of Candida albicans,Candida tropicalis and Candida glabrata to ketoconazole were low(less than 5.00%),and their resistance rates to fluconazole,amphotericin B and 5-fluorocytosine were high(greater than or equal to 50.00%).Conclusion:The main pathogenic bacteria of nosocomial pulmonary infection in patients with APLC undergoing chemotherapy are Gram-negative bacteria.The main pathogenic bacteria have a high resistance rate to most antibacterials.Clinically,the antibacterials with high sensitivity rate should be selected according to the results of drug susceptibility test to effectively control the pulmonary infection.