肺癌患者并发非发酵菌肺部感染的病原菌分布与耐药性分析

Analysis of pathogen distribution and drug resistance in patients with lung cancer complicating non-fermentative bacteria lung infection

目的分析肺癌患者并发非发酵菌肺部感染的病原菌分布及耐药特征,为临床医师预防感染,合理选用抗菌药物提供依据。方法回顾性分析2009年1月至2015年7月该院肺癌患者临床送检的呼吸道标本,检出的病原菌采用法国生物梅里埃公司Vitek2-Compact鉴定仪进行鉴定,药敏试验用纸片扩散(K-B)法,按美国临床和实验室标准化协会(CLSI)标准判定药敏试验结果,采用Whonet 5.6软件进行数据统计分析。结果 176株非发酵菌主要来自痰液,占80.1%,以铜绿假单胞菌检出率最高,占48.2%,其次是鲍氏不动杆菌和嗜麦芽寡养单胞菌,分别为32.4%、16.5%;药敏试验表明非发酵菌对抗菌药物具有不同程度耐药甚至多重耐药,其中铜绿假单胞菌对阿米卡星、妥布霉素及头孢哌酮/舒巴坦,鲍曼不动杆菌对阿米卡星、头孢哌酮/舒巴坦,嗜麦芽寡养单胞菌对米诺环素、复方磺胺甲噁唑和头孢哌酮/舒巴坦,耐药率均小于30.0%,对其余抗菌药物的耐药率大于30.0%。结论非发酵菌是医院感染常见病原菌,从该院肺癌并发肺部感染患者中分离出的非发酵菌对常用抗菌药物耐药情况严重,临床应加强病原菌及耐药性监测,治疗该类细菌感染首选头孢哌酮/舒巴坦。

Objective To analyze the pathogen distribution and drug-resistance characteristics in the patients with lung cancer complicating non-fermentative bacteria lung infection to provide the basis for clinicians to prevent infection and rationally use antibacterial drugs.Methods The clinically submitted respiratory tract specimens in the patients with lung cancer in our hospital from January 2009 to July 2015 were retrospectively analyzed.The isolated pathogenic bacteria were identified by adopting the France Bio-plum-Egyptian company Vitek2-Compact identification instrument,the drug sensitivity test was conducted by using the K-B disk diffusion method.The statistical analysis of data was performed by adopting the WHONET 5.6software.Results 176 strains of non-fermentative bacteria mainly came from sputum,accounting for 80.1%,the detection rate of Pseudomonas aeruginosa was highest,accounting for 48.2%,followed by Acinetobacter baumannii and Stenotrophomonas maltophilia,accounting for 32.4% and16.5% respectively;the drug susceptibility test results showed that non-fermentative bacteria had different degrees of resistance to antibacterial drugs or even multiple drug resistance,in which the resistance of Pseudomonas aeruginosa to amikacin,tobramycin and cefoperazone/sulbactam,the resistance of Acinetobacter baumannii to amikacin,cefoperazone/sulbactam and the resistance of Stenotrophomonas maltophilia to minocycline,cotrimoxazole and cefoperazone/sulbactam were less than 30.0%,which to other antibacterial drugs were more than 30.0%.Conclusion Non-fermentative bacteria are common pathogenic bacteria in hospital infection,non-fermentative bacteria isolated from the patients with lung cancer complicating pulmonary infection have serious resistance to commonly used antibacterial drugs,therefore clinic should strengthen the monitoring of pathogenic bacteria and drug resistance.Cefoperazone/sulbactam is the first choice for treating these bacterial infections.