肿瘤患者下呼吸道感染病原体监测与耐药分析

Distribution and drug resistance of pathogens causing lower respiratory tract infections in tumor patients

目的：了解肿瘤患者下呼吸道感染病原体的特点和耐药趋势，为临床科学合理使用抗菌药物提供参考。方法回顾性分析2010年1月－2013年3月医院微生物室检出的肿瘤患者下呼吸道感染病原体和药敏试验结果，药敏试验采用CLSI推荐的K‐B纸片法进行；数据库资料用Excel表格导出。结果检出病原体355株，其中革兰阴性菌171株占48．17％，真菌155株占43．66％，革兰阳性菌28株占7．89％，解脲脲支原体1株占0．28％；白色假丝酵母菌对伊曲康唑、氟康唑、酮康唑、制霉菌素的敏感性为100．00％，对氟胞嘧啶的耐药率＞75．00％；副流感嗜血菌对磺胺甲噁唑／甲氧苄啶的耐药率为93．98％，对头孢哌酮／舒巴坦、美罗培南、亚胺培南、氨曲南的敏感率为98．78％～100．00％；革兰阳性菌对庆大霉素、红霉素的耐药率为100．00％，对头孢哌酮／舒巴坦、万古霉素、利福平、利奈唑胺的敏感率为100．00％。结论白色假丝酵母菌为多次反复放化疗肿瘤患者下呼吸道感染的主要病原体，临床医师应加强监测和科学判断，避免盲目用药和经验用药导致的不良后果。

OBJECTIVE To understand the characteristics of the pathogens causing lower respiratory tract infections in the tumor patients and analyze the trend of drug resistance so as to provide guidance for reasonable clinical use of antibiotics .METHODS From Jan 2010 to Mar 2013 ,the pathogens were isolated from the tumor patients with lower respiratory tract infections in the microorganism room , the results of drug susceptibility testing were retrospectively analyzed ,the drug susceptibility testing was performed by using K‐B method recommended by the CLSI ,and the data were exported with the use of Excel spreadsheet .RESULTS A total of 355 strains of pathogens have been isolated ,including 171 （48 .17% ） strains of gram‐negative bacteria ,155 （43 .66% ） strains of fungi ,28 （7 .89% ） strains of gram‐positive bacteria , and 1 （0 .28% ） strain of Ureaplasma urealyticum . The drug susceptibility rates of the Candida albicans to itraconazole , fluconazole , ketoconazole , and nystatin were 100 .00% ,the drug resistance rate to flucytosine was more than 75 .00% ;the drug resistance rate of Haemophilus parainfluenzae to sulfamethoxazole‐trimethoprim was 93 .98% , the drug susceptibility rates to cefoperazone‐sulbactam ,meropenem ,imipenem ,and aztreonam ranged from 98 .78% to 100 .00% ;the drug resistance rates of the gram‐positive bacteria to gentamicin and erythromycin were 100 .00% ,and the drug susceptibility rates to cefoperazone‐sulbactam ,vancomycin ,rifampin ,and linezolid were 100 .00% .CONCLUSIONS The C .albicans is the predominant species of pathogen causing lower respiratory tract infection in the tumor patients undergoing repeated radiochemotherapys ,thus ,it is necessary for the clinician to strengthen the monitoring and scientific judgment so as to avoid the adverse effects induced by blind medication or empirical medication .