晚期乳腺癌患者依维莫司治疗后口腔感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing oral infections in advanced breast cancer patients after treatment with everolimus

目的探讨晚期乳腺癌患者依维莫司治疗后口腔医院感染的病原菌分布特点及对抗菌药物的耐药性,为临床合理使用抗菌药物提供参考。方法选取2013年7月-2015年5月医院应用依维莫司治疗的晚期乳腺癌患者92例,对患者口腔进行标本采集,应用法国生物梅里埃公司VITEK-2Compact全自动微生物分析系统对病原菌进行检测,应用PhoenixTM100全自动细菌鉴定仪对病原菌进行鉴定;应用K-B法对分离出的病原菌进行药敏试验;采用SPSS18.0统计软件对数据进行统计分析。结果 92例晚期乳腺癌患者中发生口腔感染11例,感染率为11.96%;分离出病原菌32株,以厌氧菌居多,23株占71.88%,以口腔链球菌、牙龈卟啉单胞菌、中间普氏菌为主,需氧菌9株占28.12%;23株厌氧菌对红霉素、磺胺甲噁唑/甲氧苄啶、克林霉素的耐药率较高,分别为91.30%、78.26%、65.22%,对四环素、头孢曲松及万古霉素的敏感率较高,敏感率均为95.65%。结论依维莫司治疗晚期乳腺癌患者后发生的口腔医院感染以厌氧菌为主,可根据药敏试验结果进行针对性的预防和治疗,以降低医院感染的发生率。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing oral infections in advanced breast cancer patients after treatment with everolimus so as to provide guidance for reasonable clinical use of antibiotics.METHODS A total of 92 patients with advanced breast cancer who were treated with everolimus from Jul 2013 to May 2015 were enrolled in the study,then the oral specimens were collected from the patients,the pathogens were detected by using VITEK-2Compact automatic microorganism analysis system of BioMérieux,France,the pathogens were identified by means of PhoenixTM100 automatic bacterial identification system,the drug susceptibility testing was carried out by using K-B method,and the statistical analysis of data was performed with the use of SPSS18.0software.RESULTS The oral infections occurred in 11 of 92patients with advanced breast cancer,with the infection rate 11.96%.Totally 32 strains of pathogens were isolated,including 23（71.88%）strains of anaerobic bacteria and 9（28.12%）strains of aerobic bacteria;the Streptococcus oralis,Porphyromonas gingivalis,and Prevotella intermedia were dominant among the anaerobic bacteria.The drug resistance rate of the 23 anaerobic bacteria isolates to erythromycin,sulfamethoxazole-trimethoprim,and clindamycin were 91.30%,78.26%,and 65.22%,respectively;the drug susceptibility rates to tetracycline,ceftriaxone,and vancomycin were 95.65%.CONCLUSION The anaerobic bacteria are dominant among the pathogens causing the oral infections in the patients with advanced breast cancer after the treatment with everolimus.It is necessary to take targeted prevention measures and conduct drug therapy based on the results of drug susceptibility testing so as to reduce the incidence of the nosocomial infections.