鼻咽癌患者放疗期间口咽细菌动态变化及耐药性分析

Kinetics of Oropharyngeal Bacteria and Drug Resistance in Patients with Nasopharyngeal Carcinoma during Radiotherapy

目的了解鼻咽癌患者在放疗过程中并发口咽感染细菌动态变化及其耐药性,为临床预防和治疗提供可靠依据。方法对150例首次住院治疗的鼻咽癌患者,在放疗前、每放疗一周后等不同时间进行咽拭子细菌培养,并对培养出的菌株及其耐药性进行分析。结果 150例患者共送检标本1 116份,培养出408株细菌,阳性率为36.56%;细菌的分布以G-杆菌为主(占77.45%),其次为真菌(占13.73%);排前五位的细菌依次为肺炎克雷伯菌、鲍曼不动杆菌、假丝酵母菌、铜绿假单胞菌、洛非氏不动杆菌。在放疗期间,总的细菌培养阳性检出率均呈上升趋势(P<0.05),铜绿假单胞菌及假丝酵母菌培养的阳性检出率也呈上升趋势(P<0.05)。其他克雷伯菌、阴沟肠杆菌、葡萄菌属、假丝酵母菌放疗前未检出,但放疗后可以检出。所检出细菌对大多数对β-内酰胺抗菌药物耐药,白色假丝酵母菌对伊曲康唑、氟康唑的耐药率分别为98.08%、73.08%。结论鼻咽癌放疗随放疗时间的增长,口咽部细菌的检出率呈上升趋势,可影响咽部的微生态平衡,应制定有针对性的口咽部细菌感染的防控措施。

Objective To investigate the kinetics of oropharyngeal bacteria and drug resistance in patients with nasopharyngeal carcinoma during radiotherapy.Methods Totally 150 nasopharyngeal carcinoma patients hospitalized for the first time were enrolled in this study.Both bacterial culture of throat swab and drug sensitive test were carried out before radiotherapy and weekly during radiotherapy.Results In 1 116 samples from 150 cases,408 bacteria strains were isolated,yielding a positive rate of 36.56%.Gram-negative bacteria was the main bacteria strains,accounting for 77.45%;fungi ranked the second,accounting for 13.73%.The top five bacteria were Klebsiella pneumoniae,Acinetobacter baumannii,Candida,Pseudomonas aeruginosa,and Los non-′s Acinetobacter.During radiation therapy,the total positive rates of bacterial culture showed an upward tendency（P0.05）;the positive rates of Pseudomonas aeruginosa and cocci culture increased（P0.05）.While Klebsiella,Enterobacter cloacae,staphylococci,and candida were not detected before radiotherapy but were detected after radiotherapy.The detected bacteria showed resistance to most beta lactam antibiotics.The rates of resistance to itraconazole and fluconazole by Candida albicans were 98.08% and 73.08%,respectively.Conclusion The detection rate of oropharyngeal bacteria increases after radiotherapy for nasopharyngeal carcinoma in a time-dependent manner,which may affect micro-ecological balance in throat.Prevention and control measures for oropharyngeal bacteria infection should be established.