179例肺癌患者院内细菌性肺炎常见病原菌及其耐药性分析

Analysis of Common Microorganisms and Antibiotic Resistance of Nosocomial Bacterial Pneumonia in 179 Patients with Lung Cancer

目的：为肺癌患者合并院内细菌性肺炎的合理抗生素应用提供科学依据。方法：回顾性分析我科自2003年～2005年共179例合并院内细菌性肺炎的肺癌患者的致病细菌种类以及对常见抗生素的耐药性。结果：肺癌患者合并院内细菌性肺炎病原细菌主要是革兰氏阴性杆菌，其中肺炎克雷伯氏菌是最常见的条件致病菌。常见病原菌中，肠杆菌科细菌（肺炎克雷伯氏菌、大肠埃希氏菌）对亚胺培南和头孢哌酮／舒巴坦的耐药性较低，耐药性分别为4．7％／0％和9．5％／10．0％；万古霉素是唯一对所有葡萄球菌敏感的抗生素，金葡菌和表葡菌对其的耐药性均为0％；鲍曼／溶血不动杆菌对亚胺培南和头孢哌酮／舒巴坦敏感，耐药性分别为22．6％和16．1％；而铜绿假单胞菌仅对头孢哌酮／舒巴坦（28．6％）敏感。头孢哌酮／舒巴坦是唯一的对主要致病菌均较敏感的抗生素。结论：我科的经验表明对于肺癌患者合并院内细菌性肺炎，在应用普通抗生素效果差而且多次痰培养未检测出明确病原菌的情况下，头孢哌酮／舒巴坦是临床治疗中理想的经验性选择。

Objective： To provide scientific evidence of rational application of antibiotics for nosocomial bacterial pneumonia （NBP） among lung cancer patients. Method： Retrospectively analyzed the common microorganisms and their antibiotic resistance （AR） of NBP in 179 lung cancer patients from 2003 to 2005. Result： G- negative bacilli were the common pathogens in NBP among lung cancer patients, and the Klebsiella pneumoniae was the most common one. In analysis of AR, Klebsiella pneumoniae and Escherichia coli were at lower AR for Imipenem and Cefopera/sulba, with rates of 4.7%/0% and 9.5%/10.0% respectively; Vancomysin was the only antibiotic effective for staphylococcus （Staphylococcus aureus and Staphylococcus epidermidis） with an AR rate of 0% ; Acinetobacter bau,nannii/haemolyticus was sensitive for Imipenem and Cefopera/sulba, AR were 22.6% and 16.1% respectively; and Cefopera/sulba was the only sensitive drug for Pseudomonas aeruginosa （AR 28.6% ）. Cefopera/sulba was the only antibiotic for the most common pathogens in NBP among lung cancer patients. Conclusion： Our experiences indicated that for NBP among lung cancer patients, if the normal antibiotics were not effective and there was no exact pathogen isolated from sputum, Cefopera/sulba was the ideal trial choice in clinical practice.