鼻咽癌患者医院感染病原菌的耐药性分析

Antimicrobial resistance of pathogenic bacteria causing nosocomial infections in patients with nasopharyngeal carcinoma

目的了解鼻咽癌患者医院感染的常见部位、病原菌分布及耐药性,为临床医师抗感染用药提供实验室参考指南。方法查阅统计湖北省3所医院鼻咽癌合并医院感染患者的临床资料,病原菌分离培养与种型鉴定依据临床细菌学检验技术规范进行试验操作,产超广谱β-内酰胺酶(ESBLs)鉴定依据CLSI 2010年规定的新折点,MRS鉴定采用CLSI规定的头孢西丁纸片法,药敏试验采用的K-B法,临床细菌学检验全过程实行质量控制。结果从103例鼻咽癌合并医院感染患者感染性标本中分离出病原菌144株,感染部位以呼吸道感染最多占64.9%,其次为口腔黏膜感染占17.5%;病原菌以革兰阴性菌为主,占65.3%,其次是革兰阳性菌,占23.6%;大部分病原菌显示出严重的耐药性,未检出耐糖肽类药物革兰阳性菌;耐甲氧西林葡萄球菌检出率为46.9%,产ESBLs细菌检出率为48.6%,耐亚胺培南铜绿假单胞菌和鲍氏不动杆菌检出率分别为28.6%、33.3%。结论导致鼻咽癌患者医院感染的病原菌多为常见耐药病原菌,感染部位常见于呼吸道和泌尿道,建议严格管理抗菌药物,按照病原菌药敏试验规范用药,有效控制鼻咽癌患者发生多药耐药菌医院感染。

OBJECTIVE To approach the predilection sites,species and antimicrobial resistance of pathogenic bacteria causing nosocomial infections in patients with nasopharyngeal carcinoma so as to provide laboratory guidelines for use of antibiotics for anti-infection treatment.METHODS The medical records that were collected from the nasopharyngeal carcinoma patients complicated with nosocomial infections who were treated in three hospitals of Hubei province were reviewed,the isolation,culture,and identification of the pathogens were performed in accordance with the technical standards for clinical bacteriological examination,the extended-spectrum-lactamases（ESBLs）were identified on the basis of new breakpoints of CLSI2010,the identification of MRS was conducted by using cefoxitin disk method specified by CLSI,the drug susceptibility testing was performed with the use of K-B method,and the quality control was carried out throughout the clinical bacteriological examination.RESULTS A total of 144 strains of pathogens have been cultured from the infective specimens that were obtained from the 103 nasopharyngeal carcinoma patients complicated with nosocomial infections,among whom the patients with respiratory tract infections accounted for 64.9%,the patients with oral mucosa infections 17.5%;of the pathogens isolated,65.3% were the gram-negative bacilli,and 23.6% were the gram-positive cocci.Most of the pathogens showed high drug resistance,no strain of glycopeptide-resistant gram-positive cocci was detected;the isolation rate of the methicillin-resistant Staphylococcus was 46.9%,the isolation rate of the ESBLs-producing bacteria was48.6%,and the isolation rates of the imipenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii were 28.6% and 33.3%,respectively.CONCLUSION Most of the pathogens causing nosocomial infections in the patients with nasopharyngeal carcinoma are the common drug-resistant strains;the respiratory tract and urinary tract are the most common infection sites.It is suggested that the antibiotics should be strictly administrated and reasonably used on the basis of the results of drug susceptibility testing so as to effectively control the multidrugresistant bacteria infections in the patients with nasopharyngeal carcinoma.