恶性肿瘤患者肺部感染的病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing pulmonary infections in malignant tumor patients in some hospitals in Qingdao area

目的分析恶性肿瘤患者肺部感染病原菌的分布特点及其耐药性,为临床合理用药和控制医院感染提供依据。方法对2010年1月-2011年12月住院肿瘤患者肺部感染分离出的1020株病原菌分布特点及耐药性进行统计分析。结果两年共分离出病原菌1020株,其中革兰阴性杆菌659株占64.6%,革兰阳性球菌155株占15.2%,真菌206株占20.2%,排名前5位病原菌依次为白色假丝酵母菌、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌,分别占13.3%、12.1%、9.6%、8.3%、8.1%;革兰阴性杆菌对氨苄西林的耐药率>85.0%,对庆大霉素、磺胺甲噁唑/甲氧苄啶和妥布霉素的耐药率均>30.0%;革兰阳性球菌中的葡萄球菌属对青霉素、红霉素的耐药率均>80.0%,肠球菌属对红霉素的耐药率>90.0%;常见真菌除伊曲康唑外,对氟胞嘧啶、伏立康唑、氟康唑、两性霉素B的耐药率均<10.0%。结论加强恶性肿瘤患者肺部感染的病原学检查和耐药监测,能有效指导临床合理用药及控制医院感染。

OBJECTIVE To analyze the distribution and drug resistance of pathogens causing pulmonary infections in malignant tumor patients so as to provide reference for the clinical rational use of drug and control of nosocomial infections. METHODS The characteristics of distribution of 1020 strains of pathogens isolated from the hospitalized tumor patients from Jan 2010 to Dec 2011 were analyzed, and the statistical analysis of the drug resistance was performed. RESULTS A total of 1020 strains of pathogens were isolated during the past two years, among which there were 659 （64. 6%） strains of gram-negative bacilli, 155 （15. 2%） strains of gram-positive cocci, 206 （20.2%） strains of fungi. The Candida albicans （13.3%） , Klebsiella pneumoniae （12.1%）, Escherichia coli （9.6%）, Pseudomonas aeruginosa （8.3 %）, and Acinetobacter baumannii （8.1%） ranked the top five species of pathogens. The drug resistance rate of gram-negative bacilli to ampicillin was higher than 85.0%, the resistance rates to gentamicin, sulfamethoxazole-trimethoprim, and tobramycin were more than 30.0% ; among the grampositive cocci,the drug resistance rates of Staphylococcus to penicillin and erythromycin were more than 80.0 %, the resistance rate of Enterococci to erythromycin was more than 90.0%; the drug resistance rates of the common species of fungi to 5-flucytosine, voriconazole, fluconazole, and amphotericin except for the itraconazole were less than 10. 0%. CONCLUSION To enhance the etiological examination of the malignant tumor patients with pulmonary infections and the surveillance of drug resistance may contribute to the reasonable clinical use of antibiotics and the control of nosocomial infections.