肺癌患者化疗后肺部感染病原菌分布与耐药性分析

Pathogenic bacteria distribution and drug resistance of pulmonary infection after chemotherapy of patients with lung cancer

目的探讨肺癌患者化疗后肺部感染病原菌的分布与耐药情况。方法采用回顾性分析,对2012年9月至2015年8月江苏省南京市高淳人民医院324例肺癌化疗后合并肺部感染患者分离的396株病原菌分布及耐药性进行分析。结果革兰阴性杆菌的检出率为70.70%,以肺炎克雷伯菌为主,其次是铜绿假单胞菌。革兰阳性球菌的检出率为15.10%,以金黄色葡萄球菌和肺炎链球菌为主。真菌的检出率为14.10%,以白色念珠菌为主。药敏结果显示,肺炎克雷伯菌和大肠埃希菌对头孢菌素类、氨苄西林的耐药性较高,对碳青霉烯类和哌拉西林/他唑巴坦的耐药性较低。铜绿假单胞菌除对碳青霉烯类和哌拉西林/他唑巴坦的耐药性较低外,对其他抗菌药物耐药性较高。鲍曼不动杆菌对多种抗菌药物耐药。革兰阳性球菌对红霉素、克林霉素等耐药性较高,未发现耐万古霉素和利奈唑胺的细菌。真菌对抗真菌药敏感度高。结论肺癌患者化疗后肺部感染的病原菌耐药性较高,临床应加强抗菌药物的合理使用,尽早根据药敏结果选择抗菌药物。

Objective To evaluate the pathogenic bacteria distribution and resistance to antibiotics of lung infection after chemotherapy in patients with lung cancer.Methods From September 2012 to August 2015,a total of 396 strains of pathogenic bacteria were separated from 324 cases of pulmonary infection after chemotherapy in patients with lung cancer.Pathogenic bacteria distribution and resistance to antibiotics were detected through retrospective review.Results Gram negative bacteria detection rate was70.70%,mainly by Klebsiella pneumoniae and Pseudomnas aeruginosa.Gram positive cocci detection rate was 15.10%,mainly by Staphylococcus auerus and Streptococcus pneumoniae.Fungi detection rate was 14.10%,mainly by Candida.Among Gram negative bacteria,Klebsiella pneumoniae and Eschericha coli were both highly resistant to ampicillin and cephalosporin but highly sensitive to meropenem,imipenem and piperaciilin/sulbactam.Pseudomnas aeruginosa was highly sensitive to meropenem,followed by imipenem and piperaciilin/sulbactam but highly resistant to other antibiotic.Acinetobacter baumannii was resistant to many antibiotics.Gram positive cocci was highly resistant to erythromycin and clindamycin.The susceptibility of Gram positive cocci to Vancomycin and linezolid were 100.00%.Fungi were almost sensitive to the antifungal agents.Conclusion Pulmonary infection after chemotherapy in patients with lung cancer have high drug resistance for pathogenic bacteria.Clinical rational use of antibiotics should be strengthened as soon as possible according to the choice of antibiotic susceptibility of antibiotic use.