老年NSCLC放化疗患者医院感染致病菌的耐药性筛查及对策研究

Screening and Countermeasures of Drug Resistance of Nosocomial Infections in Elderly Patients with NSCLC Chemoradiotherapy

目的研究老年非小细胞肺癌(NSCLC)放化疗患者医院感染致病菌的耐药性及对策。方法选取老年NSCLC放化疗者618例,重点监测医院感染者致病菌分布、耐药性。根据耐药性筛查结果,总结相应对策。结果医院感染149例,感染率24.11%,其中呼吸道感染构成比78.52%,高于泌尿道10.74%、胃肠道9.40%,差异有统计学意义(P<0.05)。共检出病原菌216株,其中革兰阴性菌154株(71.30%)、革兰阳性菌56株(25.93%)、真菌6株(2.78%),革兰阴性菌构成比高于革兰阳性菌、真菌构成比,差异有统计学意义(P<0.05)。铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、头孢西丁耐药性高于其他抗菌药物;肺炎克雷伯杆菌产超广谱β内酰胺酶对氨苄西林、头孢唑啉、头孢西丁耐药性高于其他抗菌药物,不产超广谱β内酰胺酶对头孢唑啉、头孢西丁耐药性高于其他抗菌药物;鲍曼不动杆菌对头孢唑啉、头孢西丁耐药性高于其他抗菌药物;大肠埃希菌产超广谱β内酰胺酶对氨苄西林、头孢唑啉、头孢西丁耐药性高于其他抗菌药物,不产超广谱β内酰胺酶对头孢唑啉耐药性高于其他抗菌药物;阴沟肠杆菌对头孢唑啉、头孢西丁耐药性高于其他抗菌药物,差异均有统计学意义(P<0.05)。金黄色葡萄球菌对青霉素G、苯唑西林、四环素、氧氟沙星耐药性高于其他抗菌药物,粪肠球菌对青霉素G、苯唑西林、四环素耐药性高于其他抗菌药物,溶血性链球菌对苯唑西林、四环素、氧氟沙星耐药性高于其他抗菌药物,差异均有统计学意义(P<0.05)。结论本地区老年NSCLC放化疗医院感染者致病菌耐药性并未出现明显变化,但真菌的出现需引起临床重视;且定期加强老年NSCLC放化疗医院感染者致病菌耐药性监测,及时采取相应防控对策,防止和延缓致病菌耐药性产生,控制或避免致病菌及其耐药菌株播散与流行的暴发。

Objective To study the drug resistance and countermeasures of nosocomial infection pathogens in elderly patients with non-small cell lung cancer(NSCLC).Methods 618 elderly patients who received NSCLC chemoradiotherapy were selected to monitor the distribution and drug resistance of the pathogens.According to the results of drug resistance screening,the corresponding countermeasures were summarized.Results There were 149 cases of nosocomial infection and 24.11%of the infection rate.The constituent ratio of respiratory tract infection was 78.52%,higher than that of urinary tract 10.74%and gastrointestinal tract 9.40%,and the difference was statistically significant(P<0.05).216 strains of pathogens were detected,154 strains of Gram-negative bacteria were detected,the detection rate was 71.30%,Gram-positive bacteria were 56,the detection rate was 25.93%,6 fungi were detected,and the detection rate was 2.78%.The constituent ratio of Gram-negative bacteria was higher than that of Gram-positive bacteria and fungi,and the difference was statistically significant(P<0.05).The composition of Pseudomonas aeruginosa was 33.80%.The resistance of Pseudomonas aeruginosa to ampicillin,ampicillin/Shubatan,cefazolin and cefoxitin was higher than that of other antibiotics,and Klebsiella pneumoniae produced a higher resistance to ampicillin,cefazolin and cefoxitin than other antibiotics,and no broad-spectrum beta lactamase was produced for cefazolin.The drug resistance of cefoxitin was higher than that of other antibiotics;the resistance of Acinetobacter Bauman to cefazolin and cefoxitin was higher than that of other antibiotics;the resistance of Escherichia coli to ampicillin,cefazolin and cefoxitin was higher than that of othe-r antibiotics and does not produce hyper broad-spectrum beta lactamase to cefazolin.The drug resistance was higher than that of other antibiotics,and the resistance of Enterobacteriaceae to cefazolin and cefoxitin was higher than that of other antibacterials,and the difference was statistically significant(P<0.05).The resistance of Staphylococcus aureus to penicillin G,oxacillin,tetracycline and ofloxacin was higher than that of other antibiotics.The resistance of Enterococcus faecalis to penicillin G,oxacillin and tetracycline was higher than that of other antibiotics.The resistance of Streptococcus hemolytic streptococcus to oxacillin,tetracycline and oxofloxacin was higher than that of other antibiotics.The difference was statistically significant(P<0.05).ConclusionThere is no obvious change in the drug resistance of pathogenic bacteria in the elderly patients with NSCLC radiotherapy and chemotherapy in the local area.However,the appearance of fungi should be paid attention to,and the monitoring of drug resistance of pathogenic bacteria in the elderly patients with NSCLC radiotherapy and chemotherapy is regularly strengthened and the corresponding prevention and control measures are taken in time to prevent and delay the drug resistance of pathogenic bacteria.It can control or avoid the spread and epidemic outbreak of pathogenic bacteria and drug-resistant strains.