肺癌患者化疗后肺部感染病原菌分布及耐药性分析

Distribution and drug resistance of respiratory infection pathogens in patients with lung cancer after chemotherapy

目的了解肺癌患者化疗后肺部感染病原菌的构成及其耐药性,为临床合理用药提供参考。方法收集2015年1月—2020年12月海军军医大学第一附属医院170例化疗后发生肺部感染的肺癌患者呼吸道样本,分离、鉴定病原菌,并进行体外药物敏感性试验。结果170例呼吸道样本中共检出202株非重复病原菌,其中革兰阴性菌127株(62.9%),居前3位的依次为铜绿假单胞菌(35株,17.3%)、鲍曼不动杆菌(28株,13.9%)和肺炎克雷伯菌(26株,12.9%);革兰阳性菌56株(27.7%),分离率最高的是金黄色葡萄球菌(35株,17.3%);真菌19株(9.4%)。革兰阴性菌中,铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率分别为22.8%、40.7%、3.8%。革兰阳性菌中,金黄色葡萄球菌对青霉素的耐药率为88.6%,未检出对万古霉素和利奈唑胺耐药的革兰阳性菌,耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为28.6%。结论肺癌患者化疗后肺部感染主要病原菌为革兰阴性菌,主要致病菌的耐药形势不容忽视,临床应合理使用抗菌药物。

Objective To investigate the composition and drug resistance of respiratory infection pathogens in patients with lung cancer after chemotherapy,and to provide a reference for clinical treatment.Methods The pathogens were isolated from 170 respiratory infection patients with lung cancer after chemotherapy from January 2015 to April 2020,and drug susceptibility test was conducted.Results Among the 202 non-repetitive isolates,127(62.9%)isolates were Gram-negative bacteria.The top 3 pathogens were Pseudomonas aeruginosa(35 isolates,17.3%),Acinetobacter baumannii(28 isolates,13.9%)and Klebsiella pneumoniae(26 isolates,12.9%).There were 56(27.7%)isolates of Gram-positive bacteria,of which the detection rate of Staphylococcus aureus was the highest(35 isolates,17.3%).There were 19(9.4%)isolates of fungi.Drug susceptibility test showed that Pseudomonas aeruginosa,Acinetobacter baumannii and Klebsiella pneumoniae had drug resistance rate to carbapenems(22.8%,40.7%and 3.8%,respectively).The drug resistance rate of Staphylococcus aureus to penicillin was 88.6%.Gram-positive bacteria were not yet resistant to vancomycin and linezolid.The detection rate of methicillin-resistant Staphylococcus aureus(MRSA)was 28.6%.Conclusions The main pathogens isolated from respiratory infection patients with lung cancer after chemotherapy are Gram-negative bacteria,and the drug resistance is serious.Rational drugs should be used in clinic.