结直肠肿瘤患者术后院内肺部感染的病原菌分布

Analysis of pathogenic bacteria distribution of nosocomial lung infection in patients with colorectal cancer after surgery

目的探讨结直肠肿瘤患者术后发生院内肺部感染的病原菌分布及多重耐药性。方法选择2015年6月—2019年6月行结直肠肿瘤术患者324例作为研究对象,所有患者术后均完善相关检查,结合肺部感染判断标准进行评估,采用Bact/alert 3D全自动细菌培养仪完成细菌培养;采用液体稀释法完成药物敏感(药敏)试验。结果324例结直肠肿瘤术患者均完善相关检查,75例患者术后发生肺部感染,感染率为23.15%。从75例肺部感染患者中共分离出病原菌38株,排在前3位的分别为:肺炎克雷伯菌(32.93%)、鲍曼不动杆菌(18.42%)、铜绿假单胞菌(15.79%)。38株培养的病原菌中15株为多重耐药菌,排在前2位的分别为:肺炎克雷伯菌、鲍曼不动杆菌;多重耐药性分析结果表明,肺炎克雷伯菌主要对氨苄西林、替卡西林耐药;鲍曼不动杆菌主要对阿莫西林/克拉维酸、氨苄西林/舒巴坦、氨苄西林、氯霉素、四环素、头孢唑啉及头孢噻吩耐药;铜绿假单胞菌主要对阿莫西林/克拉维酸、氨曲南、氨苄西林、氯霉素、头孢唑啉及头孢噻吩耐药。结论结直肠肿瘤患者术后发生院内肺部感染率较高,病原菌分布较广,且多重耐药菌占据一定比例,应根据药敏结果选择敏感抗生素。

Objective To investigate the distribution and multi-drug resistance of pathogenic bacteria in nosocomial lung infections in patients with colorectal cancer after surgery.Methods Totally 324 patients undergoing colorectal cancer surgery from June 2015 to June 2019 were selected as the subjects.All patients completed postoperative relevant examinations and were evaluated based on the criteria for determining lung infection.Bact/alert 3D automatic bacterial culture instrument was used to complete the bacterial culture and the liquid dilution method was used to complete the drug sensitivity test.Results All 324 patients undergoing colorectal cancer surgery completed the relevant examinations,and 75 patients developed pulmonary infections after surgery,with an infection rate of 23.15%.A total of 38 strains of pathogenic bacteria were isolated from 75 patients with lung infections.The top 3 bacteria were:Klebsiella pneumoniae(32.93%),Acinetobacter baumannii(18.42%)and Pseudomonas aeruginosa(15.79%).Among 38 cultured pathogens,15 strains were multi-drug resistant,and the top 2 were Klebsiella pneumoniae and Acinetobacter baumannii.The results of multi-drug resistance analysis showed that Klebsiella pneumoniae was mainly resistant to ampicillin and ticarcillin.Acinetobacter baumannii was mainly resistant to amoxicillin/clavulanic acid,ampicillin/sulbactam,ampicillin,chloramphenicol,tetracycline,cefazolin and cephalothin.Pseudomonas aeruginosa was mainly resistant to amoxicillin/clavulanic acid,aztreonam,ampicillin,chloramphenicol,cefazolin and cephalothin.Conclusions The incidence of nosocomial lung infections in patients with colorectal cancer after surgery is relatively high,pathogenic bacteria is widely distributed and multi-drug resistance of pathogens occupies a certain proportion.Sensitive antibiotics should be selected according to the results of drug sensitivity.