肺癌患者感染病原菌分布耐药性及预防策略

Distribution drug resistance and prevention strategy of infection pathogens in lung cancer patients

目的研究肺癌患者感染病原菌分布及耐药性,并分析其预防策略。方法选择2017年1月到2021年1月在沧州市人民医院治疗的肺癌伴感染患者312例作为研究对象,采集患者下呼吸道分泌物、大小便等进行病原体培养和药敏试验;分析病原菌的分布、耐药性,并制定相应的预防策略。结果312例患者中,呼吸道感染165例(52.88%),口咽部感染79例(25.32%),泌尿道感染68例(21.80%),以呼吸道感染占比最高。312例患者中共检测出398株病原菌;其中共发现革兰氏阳性菌共212株(53.27%),其中表皮葡萄球菌(15.58%)、金黄色葡萄球菌(13.07%)占比较高;革兰氏阴性菌175株,其中肺炎克雷伯菌(15.94%)、大肠杆菌(10.05%)所占比例较大。表皮葡萄球菌、金黄色葡萄球等革兰阳性菌对常用抗菌药均具有较高的耐药性,对阿米卡星、庆大霉素和青霉素的耐药率均超过50%,对万古霉素较为敏感。肺炎克雷伯、大肠杆菌等革兰阴性菌对常用抗菌药均具有较高的耐药性,对头孢吡污、头孢唑林的耐药率均超过50%,对亚胺培南/西司他丁、亚胺培南/西司他丁较为敏感。11株真菌中,对氟康唑耐药4例,耐药性为36.36%;对伊曲康唑耐药3例,耐药性为27.27%;对酮康唑和伏立康唑耐药0例,耐药性为0.00%。结论该院肺癌感染患者病原菌的分布及菌株耐药性具有一定的特点,其中革兰阳性菌感染以表皮葡萄球菌、金黄色葡萄球菌为主,革兰阴性菌感染以肺炎克雷伯菌、大肠杆菌为主,亦存在少量真菌感染;因此临床上应加强病原学、耐药性监测,加强医院消毒管理,根据患者的药敏结果合理使用抗菌药,从而提高治疗效果,降低感染风险。

Objective To study the distribution and drug resistance of pathogens in patients with lung cancer,and analyze the prevention strategies.Methods A total of 312 cases of lung cancer patients with infection treated in our hospital from January 2017 to January 2021 were selected as the research objects.The lower respiratory tract secretions,urine and feces were collected for pathogen culture and drug sensitivity test;the distribution and drug resistance of pathogens were analyzed,and the corresponding prevention strategies were formulated.Results Of the 312 patients,165(52.88%)had respiratory tract infection,79(25.32%)had oropharyngeal infection,and 68(21.80%)had urinary tract infection.The highest proportion was respiratory infection.Among the 312 patients,398 pathogens were detected of which 212 Gram-positive bacterias(53.27%)were found of which Staphylococcus epidermidis(15.58%)and Staphylococcus aureus(13.07%)accounted for a relatively high proportion.Among 175 Gram-negative strains,Klebsiella pneumoniae(15.94%)and E.coli(10.05%)accounted for a large proportion.The resistance rate of Gram-positive bacteria,such as Staphylococcus epidermidis and Staphylococcus aureus,to amikacin,gentamicin and penicillin,was more than 50%,which was sensitive to vancomycin.Gram negative bacteria such as Klebsiella pneumoniae and E.coli have high resistance to common antibiotics,and the drug resistance rate to cefepime and cefazolin is more than 50%,and sensitive to imipenem/cilastatin and imipenem/cilastatin.Among 11 fungi,4 cases were resistant to fluconazole,36.36%,3 to itraconazole,27.27%,0 to ketoconazole and voriconazole,0.00%.Conclusion The distribution and drug resistance of pathogenic bacteria in patients with lung cancer infection in our hospital have certain characteristics,in which Gram-positive bacteria are mainly Staphylococcus epidermidis and Staphylococcus aureus,Gram-negative bacteria are mainly Klebsiella pneumoniae and Escherichia coli,and there are also a small number of fungal infections.Therefore,we should strengthen the monitoring of etiology and drug resistance,and strengthen the management of hospital disinfection Drug sensitivity results of patients,rational use of antibiotics,so as to improve the treatment effect and reduce the risk of infection.