肺肿瘤患者下呼吸道感染的病原菌检测及耐药性分析

Pathogens causing lower respiratory tract infections in lung tumor patients and drug resistance

目的分析肺肿瘤患者下呼吸道感染的病原菌分布及耐药性。方法病原菌鉴定及药敏试验标本同时接种巧克力平板、血平板、中国蓝平板假丝酵母菌显色培养基,选择优势菌致病菌进行分纯,用VITEK-60型全自动细菌鉴定仪进行菌株鉴定;按《全国临床检验操作规程》进行病原菌培养,药敏试验采用微量稀释法。结果 328例肺部恶性肿瘤合并下呼吸道细菌感染患者的痰或者下呼吸道分泌物标本中,阳性299例,阳性率为91.16%;共检出病原菌352株,以革兰阴性杆菌为主,占61.08%,主要为铜绿假单胞菌,占26.99%,其次为革兰阳性球菌,占21.02%,主要为凝固酶阴性葡萄球菌,占11.93%,真菌占17.90%,主要为白色假丝酵母菌,占13.92%;革兰阴性菌中主要病原菌对碳青霉烯类药物亚胺培南、美罗培南表现出了极高的敏感性,对三代头孢的耐药率则较高,凝固酶阴性葡萄球菌对亚胺培南、美罗培南有较好的敏感性,对磺胺甲噁唑/甲氧苄啶和红霉素的耐药性约为50.00%;两性霉素B、克霉唑抗真菌效果较好,耐药率均<10.00%。结论肺肿瘤患者易发生医院下呼吸道感染,且药物敏感性降低,细菌的耐药性增强;严格控制使用抗菌药物,增强肿瘤患者的免疫力,以利肺部感染的控制。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing lower respiratory tract infections in lung cancer patients.METHODS The identification of the pathogens and the drug susceptibility testing were performed,meanwhile,the samples were inoculated on chocolate tablet,blood agar,China Blue Flat Candida Chromogenic Medium;the predominant pathogenic bacteria were selected for the depuration;the microbiological culture was performed according to National Clinical Laboratory Operating Procedures,the drug susceptibility testing was performed with the use of microdilution method.RESULTS A total of 352 strains of pathogens were cultured from the sputum or secretions of the lower respiratory tract of 229 of 328 malignant lung cancer patients with lower respiratory tract infections,the positive rate was 91.16%,gram-negative bacilli were the predominant pathogens,accounting for 61.08%,among which Pseudomonas aeruginosa accounted for 26.99%,gram-positive cocci accounted for 21.02%,among which coagulase-negative Staphylococci accounted for 11.93%,fungi accounted for 17.90%,among which Candida albicans accounted for 13.92%;the main gram-negative bacteria were highly susceptible to carbpenems such as imipenem and meropenem,but the drug resistance rate to the third generation cephalosporins was high,and coagulase-negative Staphylococci were susceptle to imipenenm and meropenem,the drug resistance rates to sulfamethoxazole/trimethoprim and erythromycin were about 50.00%;fungi were susceptle to amphotericin B and clotrimazole,the drug resistance rates were below 10.00%.CONCLUSION The lung cancer patients are prone to lower respiratory tract infections,and drug resistance of the pathogens increases;to strictly control the application of antibiotics and intensify the immunity of the lung cancer patients can contribute to the control of pulmonary infections.