恶性肿瘤患者下呼吸道感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing lower respiratory tract infections in patients with malignant tumors

目的探讨恶性肿瘤患者下呼吸道感染病原菌分布及其耐药性,指导临床合理用药。方法选取医院2006年5月-2011年9月收治的605例恶性肿瘤患者进行回顾性分析,使用法国生物梅里埃公司ATB1525Expression全自动细菌鉴定分析仪进行菌株鉴定,使用纸片扩散法探究菌株耐药性。结果共检出病原菌605株,其中革兰阴性菌322株占53.2%,革兰阳性菌113株占18.7%,真菌170株占28.1%,排前5位的病原菌依次为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、嗜麦芽寡养单胞菌,分别占15.2%、11.4%、10.6%、8.3%、4.5%;革兰阴性菌对亚胺培南/西司他丁、头孢哌酮/舒巴坦、阿米卡星及环丙沙星耐药率较低;革兰阳性菌对万古霉素耐药率最低,敏感率达100.0%,除万古霉素外,革兰阳性菌对其他抗菌药物耐药性均较高。结论恶性肿瘤患者下呼吸道感染的主要病原菌为革兰阴性菌,革兰阴性菌对亚胺培南/西司他丁耐药率较低,革兰阳性菌对万古霉素耐药率最低,对于出现感染的患者可根据其菌种选择适合的抗菌药物进行治疗。

OBJECTIVE To explore the pathogenic bacteria distribution and drug resistance of lower respiratory tract infections in patients with malignant tumors, so as to guide the rational use of drugs in clinic. METHODS A retrospective analysis on 605 cases of malignant tumor patients admitted in our hospital from May 2006 to Sep. 2011 were taken. Bacterial strains were identified by ATB automatic bacteria identification instrument, and resist- ance of bacteria strains were studied by Kirby-Bauer method. RESULTS A total of 605 strains of pathogenic bacte- ria were detected, among which gram-negative bacteria were 322 strains, accounting for 53.2%, gram-positive bacteria 113 strains （18.7%）, fungi 170 strains （28.1%）. The top five strains were Pseudomonas aeruginosa, Escherichia coli , Klebsiella pneumoniae , Staphylococcus aureus and Stenotrophomonas maltophilia , accounting for 15.2%, 11.4%, 10.6%, 8.3% and 4.5%, respectively, gram-negative bacteria had low drug resistance to imipenem-cilastatin, cefoperazone-sulbactam, amikacin, and ciprofloxacin; gram-positive bacteria had the lowest resistant to vancomyein, and the sensitive rate was 100%. Except vancomyein, the gram-positive bacteria had higher resistant to other antibiotics. CONCLUSION The main pathogenic bacteria of lower respiratory tract infec- tions in malignant cancer patients are gram-negative bacteria, which have lower resistance to imipenem-cilastatin, and the gram-positive bacteria have the lowest resistance to vancomycin. For the infected patients, antibiotics could be chosen according to the species of pathogens.