肺癌患者化疗期间医院感染病原菌及耐药性情况分析

Analysis of pathogens and drug resistance of nosocomial infection in patients with lung cancer during chemotherapy

目的探究肺癌患者化疗期间医院感染后体内病原菌分布,并进一步分析耐药性情况。方法收集化疗期间发生医院感染的178例肺癌患者的临床资料,统计患者感染部位,并归纳分析送检标本中的病原菌株及对应的药敏结果。结果178例肺癌患者化疗期间出现感染的主要部位为呼吸道及泌尿道,其中上呼吸道感染占35.39%,下呼吸道感染占26.97%,泌尿道感染占19.66%。从178例感染患者所取标本中共分离得到196株病原菌,其中革兰阳性菌、革兰阴性菌、真菌分别为64株(32.65%)、117株(59.69%)、15株(7.65%)。金黄色葡萄球菌、屎肠球菌对青霉素、氨苄西林的耐药率均﹥90%,对环丙沙星及克林霉素的耐药率均﹥50%。铜绿假单胞菌、鲍曼不动杆菌对氨苄西林、头孢唑林、头孢曲松3种抗菌药的耐药率均为100%,且肺炎克雷伯菌对上述3种抗菌药的耐药率均﹥80%。白色假丝酵母菌对氟胞嘧啶、氟康唑及伊曲康唑的耐药率较高,均﹥50%。结论肺癌患者化疗期间发生的医院感染病原菌以革兰阴性菌为主,感染主要部位为呼吸道,分析主要病原菌类型、分布及药敏结果,可为临床合理选择抗菌药提供指导和支持。

Objective To investigate the distribution of pathogens in patients with lung cancer after nosocomial infection during chemotherapy and to further analyze the drug resistance.Method The clinical data of 178 patients with lung cancer who had nosocomial infection during chemotherapy were collected.The infection sites of the patients were counted,and the pathogenic strains and the corresponding drug sensitivity results were summarized and analyzed.Result The main sites of infection in 178 patients with lung cancer during chemotherapy were respiratory tract and urinary tract,including 63 cases of upper respiratory tract(35.39%),48 cases of lower respiratory tract(26.97%)and 35 cases of urinary tract(19.66%).A total of 196 pathogenic strains were isolated.Among them,64 strains(32.65%)were Gram-positive bacteria,117 strains(59.69%)were Gram-negative bacteria and 15 strains(7.65%)were fungi.The resistance rates of Staphylococcus aureus and Enterococcus faecium to penicillin and ampicillin were more than 90%,followed by ciprofloxacin and clindamycin,with resistance rates more than 50%.The resistance rates of Pseudomonas aeruginosa and Acinetobacter baumannii to ampicillin,cefazolin and ceftriaxone were all 100%,and the resistance rates of Klebsiella pneumoniae to the above three antibiotics were more than 80%.The resistance rates of Candida albicans to flucytosine,fluconazole and itraconazole were more than 50%.Conclusion Gram-negative bacteria is the main pathogen of nosocomial infection in patients with lung cancer during chemotherapy,and the main site of infection is respiratory tract.The analysis of the type,distribution and drug sensitivity of the main pathogens can provide guidance and support for the rational selection of antibiotics in clinic.