头面部皮肤鳞状细胞癌组织分离的细菌病原菌构成和耐药性分析

Composition of and drug resistance in bacteria isolated from the lesions of patients with squamous cell carcinoma of the face and head

目的分析头面部皮肤鳞状细胞癌组织分离的细菌病原菌构成及耐药情况。方法常规方法对246例头面部鳞状细胞癌患者的病变组织或其表面分泌物进行细菌培养，用VITEKTWO全自动微生物分析仪对分离的细菌病原菌进行鉴定，纸片扩散法对分离菌株进行药敏试验。用WHONET5．3进行统计学分析。结果共分离菌株294株，革兰阴性菌168株（57．1％），革兰阳性菌126株（42．9％）。检出率最高的五种病原菌依次为金黄色葡萄球菌（21．4％）、大肠杆菌（20．4％）、表皮葡萄球菌（18．4％）、肺炎克雷伯菌（15．4％）和铜绿假单胞菌（9．5％）。大肠杆菌和肺炎克雷伯菌产超广谱β-内酰胺酶株的检出率分别为40％和26．7％。耐甲氧西林的金黄色葡萄球菌和表皮葡萄球菌的检出率分别为42．9％和55．6％。铜绿假单胞菌、大肠杆菌和肺炎克雷伯菌对亚胺培南和美罗培南高度敏感，对β-内酰胺类和β-内酰胺酶类抑制剂复合物的敏感性较好。未发现耐万古霉素、替考拉宁以及利奈唑胺的葡萄球菌。结论头面部鳞状细胞癌组织分离的细菌以条件致病菌为主，革兰阴性菌比例略高于革兰阳性菌，对常用的抗生素有较高的耐药性。

Objective To analyze the composition of and drug resistance in bacteria isolated from the lesions of patients with squamous cell carcinoma of the face and head. Methods Lesional tissue or discharges were obtained from 246 patients with squamous cell carcinoma of the face and head, and subjected to conventional bacterial culture. The isolated bacteria were identified by VITEK TWO automated microbiology system. Antimicrobial susceptibility testing was carried out by Kirby-bauer method. WHONET 5.3 software was utilized for statistical analysis. Results Totally, 294 bacterial strains were isolated, including 168 Gram-negative bacteria （57.1%） and 126 Gram-positive bacteria（42.9%）. The bacterial isolates were predominated by Staphylococcus attreus （21.4%）, followed by Escherichia coli （20.4%）, Staphylococcus epidermidis （18.4%）, Klebsiellapneumoniae （15.4%） and Pseudomonas aeruginosa （9.5%）. The prevalence was 40%, 26.7%, 42.9% and 55.6% respectively for extended spectrum 13 lactamases-producing E. coii and K. pneumoniae, methicillinresistant staphylococcus aureus （MRSA） and methicillin-resistant coagulase-negative S. epidermidis （MRCNS） respectively. P. aeruginosa, E. coli and K. pneumoniae were highly susceptible to imipenem and meropenem, and favorably sensitive to β-lactam and β-lactamase inhibitor combination. No resistance was observed for vancomycin, teicoplanin or linezolid in staphylococci. Conclusions The bacterial isolates from squamous cell carcinoma tissue on the head and neck are predominated by conditional pathogenic bacteria, and the proportion of Gram-negative bacteria is higher than that of Gram-positive bacteria. These isolates seem to be highly resistant to common antibiotics.