鼻咽癌患者感染病原菌分布及耐药性分析

Distribution and drug resistance of infection pathogens in patients with nasopharyngeal carcinoma

目的探究鼻咽癌患者感染病原菌分布及耐药性分析。方法选取于2013年10月-2016年10月医院收治的120例鼻咽癌合并医院感染患者,采集感染部位标本行病原菌培养及鉴定,分析比较鼻咽癌患者治疗方式、病原菌感染部位、病原菌种类、主要病原菌对抗菌药物耐药性以及耐药率。结果鼻咽癌患者以口腔感染居多,感染率为64.17%,其次分别是皮肤感染和呼吸系统感染,感染率分别为20.83%和10.00%;120例鼻咽癌患者感染部位标本中共分离出137株病原菌,其中真菌73株占53.28%,革兰阴性菌50株占36.50%,革兰阳性菌14株占10.22%;白假丝酵母对灰黄霉素耐药率最低,为19.57%,对伏立康唑耐药率最高,为50.00%;热带假丝酵母对灰黄霉素耐药率为11.76%,对伏立康唑耐药率为52.94%。铜绿假单胞菌、鲍氏不动杆菌以及肺炎克雷伯菌对阿米卡星耐药率均较低,对磺胺甲噁唑/甲氧苄啶耐药率高。结论采用同期放化疗治疗的鼻咽癌患者感染率最高,发生院内感染的鼻咽癌患者感染部位常见于口腔;根据药敏分析结果规范使用抗菌药物治疗,预防鼻咽癌患者发生院内感染或降低患者发生多重感染,提高预后。

OBJECTIVE To investigate the distribution and drug resistance of pathogens in nasopharyngeal carcinoma patients.METHODS A total of 120 cases of nasopharyngeal carcinoma patients with nosocomial infections from Oct.2013 to Oct.2016 were selected,and specimens of infection sites were collected for culture and identification of pathogenic bacteria.The treatment methods,infection sites of pathogens,pathogen species,and drug resistance and resistant rates of main pathogens to antimicrobial drug were analyzed and compared.RESULTS The majority of patients with nasopharyngeal carcinoma were with oral infections,and the infection rate was 64.17%;followed by skin infections and respiratory infections,and infection rates were 20.83% and 10.00%.A total of 137 pathogens were isolated and fungal infections were the most,accounting for 53.28% of the total;followed by gram-negative bacteria（50 strains,36.50%）and gram-positive bacteria（14 strains,10.22%）.Candida albicans had the lowest resistant rate to griseofulvin,which was only 19.57%,and the highest resistant rate to voriconazole,which was 50.00%.The resistant rate of C.tropicalis to griseofulvin was 11.76%,and to voriconazole was 52.94%.Pseudomonasaeruginosa,Acinetobacter baumannii and Klebsiella pneumoniae had low resistant rates to amikacin,and high resistant rates to sulfamethoxazole/trimethoprim.CONCLUSION The patients with nasopharyngeal carcinoma treated with concurrent radiotherapy and chemotherapy have the highest infection rate.The common infection site of nasopharyngeal carcinoma patients is oral cavity.We should standardize the use of antimicrobial agents according to the results of drug sensitivity analysis,to prevent nosocomial infections or reduce multiple infections and improve prognosis in patients with nasopharyngeal carcinoma.