晚期肺癌合并慢阻肺化疗后肺部感染的病原菌耐药情况及干预对策

Drug resistance of pulmonary infection associated pathogenic bacteria in patients with advanced lung cancer and chronic obstructive pulmonary disease after chemotherapy and intervention strategies

目的探讨晚期肺癌合并慢性阻塞性肺疾病(慢阻肺)患者化疗后出现肺部感染的病原菌耐药情况及干预对策。方法选取2016年4月至2019年3月间宝鸡市中心医院行化疗治疗的77例晚期肺癌合并慢阻肺患者,筛选出化疗后出现肺部感染的患者进行痰培养,对菌种及耐药性进行分析,并对肺部感染患者对症支持治疗。结果共培养出病原菌122株,其中革兰氏阴性杆菌91株(74. 6%),革兰氏阳性菌12株(9. 8%),真菌19株(15. 6%)。药敏试验结果显示,在4种革兰氏阴性杆菌中,鲍曼不动杆菌耐药性最严重,对喹诺酮类、二代头孢类和不带酶抑制剂的三代头孢类均存在较高耐药性,对碳青霉烯类药物耐药性较高,对头孢哌酮舒巴坦和哌拉西林他唑巴坦敏感性较高。大肠埃希氏菌、铜绿假单胞菌和肺炎克雷伯菌对碳青霉烯类、阿米卡星、头孢哌酮舒巴坦和哌拉西林他唑巴坦敏感性较高。革兰氏阳性球菌对青霉素、氨苄西林、左氧氟沙星和环丙沙星耐药性高,对万古霉素、替考拉宁和利奈唑胺敏感性高。根据药敏试验结果,给予针对性的抗菌药物治疗,患者症状均得到改善,肺部感染问题逐渐得到纠正,治疗有效率为100. 0%。结论晚期肺癌合并慢阻肺患者化疗后并发肺部感染时,主要致病菌为革兰氏阴性菌,其次为真菌和革兰氏阳性菌,耐药性强,应结合痰培养和药敏试验结果,为患者选择最有效的抗菌药物治疗,保证临床效果。

Objective To investigate the drug resistance and pathogenesis of pathogenic bacteria in patients with advanced lung cancer and chronic obstructive pulmonary disease after chemotherapy. Methods Seventy-seven patients with pulmonary infection after chemotherapy were selected from patients with advanced lung cancer and chronic obstructive pulmonary disease who received chemotherapy from April 2016 and March 2019 at Baoji Central Hospital. Sputum culture test was performed on patients who were diagnosed with pulmonary infection after chemotherapy. The strains and drug resistance were analyzed and expectant treatment was given. Patients with pulmonary infections receive symptomatic supportive care.Results The results of sputum culture in 77 patients showed that 122 strains of pathogens were cultured,of which 91( 74. 6%) were Gram-negative bacteria,and 12 were Gram-positive bacteria( 9. 8%),and fungi were 19( 15. 6%). According to the results of drug susceptibility test,among the four Gram-negative bacilli,the resistance of Acinetobacter baumannii has the strongest resistance,especially to the third-generation cephalosporins of quinolones,second-generation cephalosporins and enzyme-free inhibitors were higher. Its resistance to carbapenems was high,and sensitivity to cefoperazone sulbactam and piperacillin tazobactam was high. Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae are more sensitive to carbapenems,amikacin,cefoperazone sulbactam and piperacillin tazobactam. Gram-positive cocci was highly resistant to penicillin,ampicillin,levofloxacin,and ciprofloxacin,and highly sensitive to vancomycin,teicoplanin,and linezolid. According to the results of the patient’s susceptibility test,when targeted antibiotic treatment was given,the symptoms in the patients were improved,and the problem of pulmonary infection was gradually corrected. The effective rate of treatment was 100%. Conclusion For patients with advanced lung cancer and chronic obstructive pulmonary disease,the main pathogens are Gram-negative bacteria,followed by fungi and Gram-positive bacteria,which have strong drug resistance and they should be combined with sputum. The results of the culture and drug susceptibility test helps find the most effective antibacterial therapy for the patient to ensure the clinical eficacy of the patient.