胸部恶性肿瘤患者院内细菌真菌混合感染的临床特征

Analysis of the Clinical Characteristics of Malignant Chest Tumor Patients with Nosocomial Mixed Fungal-Bacterial Mixed Infection

目的探讨院内胸部恶性肿瘤患者细菌真菌混合感染的临床特点,为预防胸部肿瘤患者细菌真菌混合感染的防治提供帮助.方法回顾性分析2007年7月至2015年6月间,对5 067例胸部恶性肿瘤存在感染征象患者的痰液、血液、尿液、胸腹水、手术切口、以及植入医用生物材料等行病原菌培养及鉴定,检出细菌真菌混合感染病例142例.分析其临床特征、标本来源、病原菌构成、病种类型、医疗干预情况等情况.结果 142例患者中临床分期III^IV期患者104例(73.2%),使用抗生素≥14 d 94例(66.2%);存在生物材料植入患者104例(74.7%),死亡96例(67.6%);共分离细菌167株其中G+菌61株,占36.5%,以表皮葡萄球菌、金黄色葡萄球菌为主;G-菌106株,占63.5%,以肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌为主;分离真菌172株,以白色念珠菌为主,占77.3%.病原菌标本主要来源于痰液+咽试纸、血培养与医用植入材料表面.72例肺癌患者中鳞癌与小细胞癌分别52.8%、33.3%,远高于腺癌12.5%;42例食管癌患者中术后患者为42.9%,肠外营养大于10 d患者为80.9%,高于肠外营养小于10 d患者19.1%.结论胸部恶性肿瘤细菌真菌混合感染细菌多见于葡萄球菌、肺炎克雷伯菌、大肠埃希菌,真菌以白色念珠为主.对于临床III^IV期、肠外营养≥10 d、有化放疗史、抗菌药物≥14 d、有医用生物材料植入的胸部恶性肿瘤患者,需警惕细菌真菌混合感染的发生.

Objective To explore the clinical characteristics of and to provide help to the prevention and treatment of malignant chest tumor with nosocomial mixed fungal-bacterial infection. Methods From July 2007 to June 2015,pathogenic bacteria in sputum,blood,urine,chest incision,thoracic and abdominal fluid, and implantable medical biological material were cultivated in 5067 patients with malignant chest tumor suspected with infection. The clinical characteristics, source of specimen and pathogenic bacteria, the types of diseases,medical intervention activities of 142 cases detected with mixed fungal-bacterial infection were retrospectively analyzed. Result In 142 patients, 104 patients at clinical stage III- IV accounted for 73.2%, and 94 patients used antibiotics more than 14 days（66.2%）;104 cases had implanted biological materials（74.7%）;96 cases died（67.6%）. A total of 167 strains bacteria were isolated. Sixty-one strains of G＋ bacteria accounting for36.5% were mainly Epidermis staphylococcus and Staphylococcus aureus;106 strains of G- bacteria accounting for 63.5% were mainly klebsiella pneumonia, Escherichia coli and baumanii; 172 strains fungus mainly of Candida albicans were isolated（77.3%）. Pathogenic bacteria sources were mainly sputum specimens ＋ pharynx strip, blood culture and medical implant materials. In 72 lung cancer patients,squamous carcinoma and small cell carcinoma were 52.8% and 33.3% respectively, higher than adenocarcinoma（12.5%）; In 42 esophageal cancer patients, postoperative patients were 42.9%. Parenteral nutrition patients with more than 10 days were80.9% higher than that of parenteral nutrition in patients with less than 10 days（19.1%）. Conclusion Among malignant chest tumor patients with nosocomial mixed fungal-bacterial infection, the bacteria were found in staphylococcus aureus,klebsiella pneumoniae and E. coli and the fungus was Candida albicans. For clinical stage III- IV,patients with parenteral nutrition for more than 10 days,having history of chemo or radiotherapy,with antimicrobial use for more than 14 days, and with implanted biological materials, should be warned about nosocomial mixed fungal-bacterial infection.