肺癌患者合并肺脓肿感染的特点与防治研究

Characteristics of lung cancer patients complicated with lung abscess infections and prevention strategies

目的研究肺癌患者肺脓肿感染病原菌分布、耐药性以及预防,以降低感染发生。方法对2012年5月-2015年5月医院治疗的308例肺癌患者临床资料进行回顾性分析,并对45例感染肺脓肿的患者进行痰液病原菌培养以及药敏试验,对病原菌分布特点以及耐药性进行分析,提出预防治疗措施。结果肺癌合并肺脓肿患者45例,感染率为14.61%;检出病原菌分别为革兰阴性菌、革兰阳性菌及真菌,分别占53.66%、34.15%、12.19%,检出以金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌为主,分别占19.51%、23.17%、13.41%;革兰阳性菌对阿米卡星、头孢哌酮/舒巴坦、亚胺培南/西司他丁、万古霉素的耐药性较低;铜绿假单胞菌对阿米卡星、头孢哌酮/舒巴坦、妥布霉素、亚胺培南/西司他丁的耐药性较低;大肠埃希菌对亚胺培南以及亚胺培南/西司他丁具有较低的耐药性;肺炎克雷伯菌对亚胺培南/西司他丁以及米诺环素的耐药率较低。结论肺癌患者肺脓肿的感染率相对较高,应及时对患者痰液进行培养鉴别以及药敏试验,根据试验结果合理的选用抗菌药物,提高治疗效果。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing lung abscess infections in lung cancer patients and put forward the prevention measures so as to reduce the incidence of the infections.METHODS The clinical data of 308 lung cancer patients who were treated in the hospital from May 2012 to May2015were retrospectively analyzed.The sputum culture was carried out for 45 patients complicated with lung abscess infections,the drug susceptibility testing was performed,the distribution and drug resistance of the pathogens were observed,and the prevention measures were put forward.RESULTS The lung abscess infections occurred in 45 of 308lung cancer patients,with the infection rate of 14.61%.Among the isolated pathogens,53.66% were gram-negative bacteria,34.15% were gram-positive bacteria,and 12.19% were fungi.Staphylococcus aureus,Pseudomonas aeruginosa,and Klebsiella pneumoniae were dominant among the pathogens,accounting for 19.51%,23.17%,and 13.41%,respectively.The drug resistance rates of the gram-positive bacteria to amikacin,cefoperazone-sulbactam,imipenem-cilastatin,and vancomycin were low;the drug resistance rates of P.aeruginosato amikacin,cefoperazone-sulbactam,tobramycin,and imipenem-cilastatin were low;the drug resistance rates of Escherichia coli to imipenem and imipenem-cilastatin were low;the drug resistance rates of K.pneumoniae to imipenem-cilastatin and minocycline were low.CONCLUSIONThe incidence of lung abscess infections is high in the lung cancer patients.It is necessary to carry out the sputum culture and drug susceptibility testing in a timely manner and reasonably use antibiotics based on the results of the drug susceptibility testing so as to improve the therapeutic effect.