恶性肿瘤患者肺部感染细菌分布及耐药分析

Analysis on Bacterial Distribution and Drug Resistance in Patients with Malignant Tumors Complicated with Pulmonary Infection

目的分析医院恶性肿瘤并发肺部感染患者的细菌分布及耐药情况,为临床合理使用抗菌药物提供依据。方法统计、分析医院2016年恶性肿瘤伴肺部感染患者病原菌分布特点及耐药性。结果共分离出病原菌617株,其中革兰阴性杆菌496株(占80.39%),革兰阳性球菌109株(占17.67%),真菌12株(占1.94%);分离出的前5位病原菌,分别是肺炎克雷伯菌(20.26%)、铜绿假单胞菌(19.77%)、流感嗜血杆菌(19.61%)、金黄色葡萄球菌(9.89%)、肺炎链球菌(6.32%)。肺炎克雷伯菌对碳青霉烯类抗生素敏感;铜绿假单胞菌对氨曲南的耐药率为32.80%,对碳青霉烯类抗生素和头孢他啶等抗生素的敏感性都在85.00%以上;流感嗜血杆菌对除了氨苄西林和复方新诺明外的临床常用抗菌药物都比较敏感。未发现耐万古霉素、替加环素、奎奴普丁达福普汀、利奈唑胺、利福平的金黄色葡萄球菌菌株和耐万古霉素、利奈唑胺的肺炎链球菌菌株,肺炎链球菌对青霉素的耐药率为5.13%。结论做好医院耐药性监测,有助于指导临床医生合理选择抗菌药物,可有效减少医院耐药菌株的产生。

Objective To analyze the bacterial distribution and drug resistance of patients with malignant tumors complicated with pulmonary infection,and to provide the basis for the rational use of antimicrobial agents. Methods The distribution characteristics and drug resistance of pathogens in patients with malignant tumors complicated with pulmonary infection in 2016 were statistically analyzed.Results A total of 617 strains of pathogenic bacteria were isolated, including 496 strains（ 80. 39%） of gram-negative bacilli, 109 strains（ 17. 67%） of Gram-positive cocci, 12 strains of fungi（ 1. 94%）. The top 5 pathogens were as follows： Klebsiella pneumoniae（ 20. 26%）, Pseudomonas aeruginosa（ 19. 77%）, Haemophilus influenzae（ 19. 61%）, Staphylococcus aureus（ 9. 89%）, Streptococcus pneumoniae（ 6. 32%）. Klebsiella pneumoniae was sensitive to carbapenem antibiotics. The resistant rate of Pseudomonas aeruginosa to aztreonam was32. 80%, the sensitivity of Pseudomonas aeruginosa to carbapenem antibiotics and ceftazidime and other antibiotics was more than85. 00%. Haemophilus influenzae was sensitive to clinically common antimicrobial agents other than amoxicillin and cotrimoxazole.Staphylococcus aureus strains resistant to vancomycin,tigecycline,quinuprine/dalfopristin,linezolid,rifampicin and Streptococcus pneumoniae resistant strains of vancomycin and linezolid were not found, the resistant rate of Streptococcus pneumoniae to penicillin was 5. 13%.Conclusion Monitoring of drug resistance might help to guide clinicians to choose antibiotics rationally and effectively reduce the emergence of hospital-resistant strains.