食管癌患者术后肺部感染的病原菌耐药性监测

The study of drug resistance of pathogens in esophageal cancer postoperative pulmonary infetion

目的探讨食管癌患者术后发生肺部感染的临床诊断方法和病原菌的耐药性，以期为提高食管癌术后肺部感染的诊治水平提供参考。方法选取2010年3月-2013年3月医院收治的食管癌手术患者867例，其中发生肺部感染130例；对其临床资料进行回顾分析，统计病原菌分类和其耐药性，采用SPSS13．0软件进行分析，计量资料采用t检验，计数资料采用x^2检验。结果130例食管癌术后并发肺部感染的患者共检出病原菌233株，以革兰阴性菌最多，共检出179株占76．82％，其中铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌和大肠埃希菌检出率最高，分别占15．02％、12．02％、9．44％和8．58％，革兰阳性菌检出37株，占15．88％，其中以金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌和肠球菌属最为常见，分别占8．15％、3．86％、1．72％和1．29％，真菌检出最低，共17株，占7．30％；所有革兰阴性菌均对美洛西林、头孢曲松以及环丙沙星表现出了较高的耐药性，耐药率〉50．00％，铜绿假单胞菌和鲍氏不动杆菌对头孢他啶和左氧氟沙星表现出较高的耐药性，耐药率在59．09％～74．29％，革兰阴性菌对亚胺培南耐药率〈32．00％；所有革兰阳性菌均对青霉素、苯唑西林、头孢唑林、阿奇霉素和环丙沙星表现出了较高的耐药性，耐药率〉50．00％，而普遍对万古霉素敏感，无耐药菌株检出。结论食管癌术后并发肺部感染影响患者的康复和治疗，同时影响预后；临床中应根据患者的临床表现，及时采取相应辅助检查进行确诊，并通过细菌培养和药敏试验选择适宜的抗菌药物进行及时治疗，在药敏试验结果报告之前，可根据经验先给予相应的治疗。

OBJECTIVE To investigate the clinical diagnostic methods and resistance of pathogens in esophageal cancer postoperative pulmonary infection. in order to improve the reference of diagnosis and treatment of esophageal cancer postoperrtive pulmonary infection. METHODS 867 cases of patients with esophageal cancer. including 130 cases of pulmonary infection were analyzed. Clinical data were retrospectivly analyzed. strains classification and drug resistance were statisticauy andhyzed with SPSSI3. 0 software The measure dta was anaryzed with to test. the conrt data was anahped with chi-sqnere. RESULTS A totau of strans were 130loted from 233. Most of stranins were Gram-negative bacteria. which detected in 179. accounting for 76. 82 %. Pseudomonas aeruginosa , Klebsiella pneumoniae , Acinetobacter baumannii and Escherichia coli were doninant pathogens with the isolation tate of 15. 02%. 12.02%. 9.44% and 8.58%. respectively. All of Gram-negative bacteria shoned higher mezlocillin , ceftriaxone and ciprofloxacin resistance. P. aeruginosa and A. baumanri showed higher resistance to ceftazidime. and lvofloxaain with the resistance rate fom 59. 09 % to 74. 29 % all of Gram-negative bacteria were susceptibl to impenem 37of. Gram-positive bacteria were detected. accounting for 15.88%. Staphylococcus aureus. Staphylococcus epidermidis , Staphylococcus haemolytic us and Enterococcus were most common. accounting for 8. 15%. 3.86%. 1. 72% and 1. 29% respectivly, Gram positive bacteria shonedthyh resisitance to penicillin. oxacillin. cefazolin , azithromycin and ciprofloxacinv and the susceptahihty to vancomycin. CONCLUSION Esophageal cancer postoperative pulmonary infection it isnecssary affects the rehabilitation. treatment and prognosis. take clinical measures timely and appropriate laboratory examinations for diagnosis should be based on the patient＇ s clinical manifestations; Appropriate choice of antibiotic treatment showld be applied timeny; Experience treatment should be given before the susceptibility test results according to experience.