晚期肺癌合并慢阻肺化疗后肺部感染的病原谱及耐药性分析

Distribution and drug resistance of pathogens causing pulmonary infections in advanced lung cancer patients complicated with chronic obstructive pulmonary disease after chemotherapy

目的探讨合并慢性阻塞性肺疾病(简称慢阻肺)的晚期肺癌患者化疗后肺部感染的病原菌分布及其耐药情况,指导临床合理用药。方法选择2011年1月至2014年5月徐州医学院附属医院呼吸科收治的65例化疗后肺部感染的晚期肺癌合并慢阻肺患者为研究对象,对所有患者痰标本中分离出的病原菌进行菌种鉴定和耐药性分析。结果共分离出103株病原菌,其中革兰阴性杆菌79株,占76.6%;革兰阳球性菌8株,占7.8%;真菌16株,占15.6%。最主要的革兰阴性杆菌依次为大肠埃希氏菌(28.2%)、铜绿假单胞菌(15.5%)、肺炎克雷伯菌(13.6%)、鲍曼不动杆菌(8.7%)、阴沟肠杆菌(5.8%)。大肠埃希氏菌、肺炎克雷伯杆菌和铜绿假单胞菌对对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星敏感性较高。鲍曼不动杆菌对碳青霉烯类药物耐药率高(55.6%),对头孢哌酮舒巴坦和哌拉西林他唑巴坦敏感性相对较好。金黄色葡萄球菌未发现对万古霉素耐药。结论合并慢阻肺的晚期肺癌化疗后肺部感染致病菌以革兰阴性杆菌为主;其次为真菌、革兰氏阳性球菌。细菌耐药情况较为严重,应结合本地区病原菌分布特点及耐药状况,合理选用抗菌药物。

Objective To explore the distribution and antibiotic resistance of pathogens causing pulmonary infections in advanced lung cancer patients complicated with chronic obstructive pulmonary disease after chemothera-py. Methods 65 advanced lung cancer patients complicated with COPD complicated with pulmonary infections after chemotherapy from January, 2011 to May, 2014 were selected in this study. Bacteria culture and drug susceptibility test were performed for the sputum samples of all patients. Results A total of 103 strains of pathogenic bacteria were isolated in 65 patients, including 79 strains of Gram-negative bacilli （76. 6% ）, 8 strains of Gram-positive cocci （7. 8% ） and 16 strains of fungi （15. 6% ）. The five predominant Gram-negative bacterial species were Escherichia coli （28. 2% ）, P. aeruginosa（15. 5% ）, Klebsiella pneumonia（13. 6% ）, Acinetobacter baumannii （8. 7% ）, and Enterobacter cloacae （5. 8% ）. Escherichia coli, Klebsiella pneumonia and Pseudomonas aeruginosa showed moder-ate susceptibility to Carbapenems, cefoperazone/ sulbactam, piperacillin/ tazobactam and amikacin. Acinetobacter baumannii showed high frequency of drug resistance to Carbapenems （55. 6% ） and relatively moderate susceptibility to cefoperazone/ sulbactam and piperacillin/ tazobactam. All the S. aureus strains in this study were sensitive to van-comycin. Conclusion The Gram-negative bacilli are the main pathogens causing pulmonary infections in advanced lung cancer patients complicated with COPD after chemotherapy, followed by fungi and gram-positive bacteria. As the problem of bacterial resistance is getting worse, antibiotics should be used more rationally according to the distribution of common pathogens and drug resistance trends in the region.