晚期肺癌患者化疗后医院感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing nosocomial infection in advanced lung cancer patients after chemotherapy

目的分析晚期肺癌患者化疗后医院感染的病原菌分布及耐药性,为制订临床治疗方案提供客观依据。方法选取2010年1月-2016年12月150例医院晚期肺癌化疗后感染患者作为研究对象,对其相关标本中的病原菌分布及耐药性进行检测和分析。结果 150例晚期肺癌患者化疗后感染主要发生于呼吸系统、泌尿系统和口咽部;共分离病原菌159株,其中,革兰阴性菌105株占66.04%,革兰阳性菌44株占27.67%,真菌10株占6.29%;革兰阴性菌中,铜绿假单胞菌对氨苄西林、头孢唑林、头孢曲松、头孢替坦的耐药率为100%;肺炎克雷伯菌对头孢唑林的耐药率为100%,鲍氏不动杆菌对氨苄西林、头孢唑林、头孢曲松、头孢替坦的耐药率均达到100%;革兰阳性菌中,金黄色葡萄球菌对青霉素G、氨苄西林、环丙沙星的耐药率均达到100%,粪肠球菌对青霉素G、氨苄西林、利福霉素的耐药率达到100%,未分离出对替考拉宁、万古霉素或利奈唑胺耐药的革兰阳性菌株;白假丝酵母菌对氟康唑、氟胞嘧啶的耐药率较高,均>60%。结论晚期肺癌患者化疗后医院感染的病原菌分布和耐药性具有一定的特征,临床医生应给予充分的重视和及时有效的诊治,以达到保障治疗效果、延长患者生存期的目的。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing nosocomial infections in advanced lung cancer patients after chemotherapy so as to put forward the clinical treatment programs.METHODS From Jan 2010 to Dec 2016,a total of 150 advanced lung cancer patients who had infections after chemotherapy were recruited as the study objects,and the distribution and drug resistance of pathogens isolated from related specimens were detected and analyzed.RESULTS The respiratory system,urinary system,and oropharynx were the major infection sites of the 150 advanced lung cancer patients after chemotherapy.Totally 159 strains of pathogens were isolated,including 105（66.04%）strains of gram-negative bacteria,44（27.67%）strains of gram-positive bacteria,and 10（6.29%）strains of fungi.Among the gram-negative bacteria,the drug resistance rate of Pseudomonas aeruginosato ampicillin,cefazolin,ceftriaxone,and cefotetan was 100%;the drug resistance rate of Klebsiella pneumoniae to cefazolin was 100%;the drug resistance rate of Acinetobacter baumannii to ampicillin,cefazolin,ceftriaxone,and cefotetan was as high as 100%.Among the gram-positive bacteria,the drug resistance rate of Staphylococcus aureus to penicillin G,ampicillin,and ciprofloxacin was as high as100%;the drug resistance rate of Enterococcus faecalis to penicillin G,ampicillin,and rifamycin was 100%;no strain of gram-positive bacteria that were resistant to teicoplanin,vancomycin,or linezolid was isolated.The drug resistance rate of Candida albicans to fluconazole and flucytosine was more than 60%.CONCLUSION The distribution and drug resistance of pathogens isolated from the advanced lung cancer patients after chemotherapy show certain characteristics.It is necessary for clinicians to attach great importance to them and conduct timely and effective diagnosis and treatment so as to ensure the therapeutic effect and prolong the survival of the patients.