食管癌根治术后肺部感染病原菌和耐药性及其耐药基因

Pathogenic bacteria isolated from esophageal cancer patients with pulmonary infection after radical resection,drug resistance and drug resistance genes

目的探究食管癌根治术后肺部感染病原菌、耐药性及其耐药基因情况。方法选择2016年6月-2019年12月于甘肃省金昌市中西医结合医院行食管癌根治术后肺部感染的98例患者为研究对象,对患者进行病原菌鉴定、药敏试验及耐药基因检测。结果98例肺部感染患者共检出112株病原菌,其中革兰阴性菌73株(65.18%),以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌为主,对氨苄西林、头孢曲松、环丙沙星、左氧氟沙星等药物耐药性较强,对美罗培南、亚胺培南敏感性较高;革兰阳性菌31株(27.68%),以金黄色葡萄球菌、表皮葡萄球菌为主,对青霉素、红霉素等药物表现出较高的耐药性,对于万古霉素、替考拉宁等药物敏感性较高。铜绿假单胞菌检出SHV、TEM、PER-1、qnrS、aac(6’)-2各1株,检出CTX-M、AmpC突变各2株;肺炎克雷伯菌、鲍氏不动杆菌均检出SHV、CTX-M、AmpC、qnrB突变各1株,肺炎克雷伯菌检出tetM突变株1株,鲍氏不动杆菌检出TEM、PER-1、qnrA、aac(6’)-2突变株各1株,金黄色葡萄球菌、表皮葡萄球菌分别检出tetM、PBP1a各1株,金黄色葡萄球菌检出qnrA、aac(6’)-2、mecA、PBP2b突变菌株1株。结论医院食管癌根治术后肺部感染病原菌对多种药物存在耐药,耐药基因突变可解释一部分耐药。

OBJECTIVE To explore the pathogens isolated from esophageal cancer patients with pulmonary infection after radical resection and analyze the drug resistance and drug resistance genes.METHODS From Jun 2016 to Dec 2019,totally 98 esophageal cancer patients who underwent radical resection surgery in Jinchang Integrated Hospital of Traditional Chinese and Western Medicine in Gansu Province and had postoperative pulmonary infection were recruited as the study subjects.The pathogens were isolated from the patients and identified,the drug susceptibility testing was performed,and the drug resistance genes were detected.RESULTS Totally 112 strains of pathogens were isolated from 98 patients with pulmonary infection,73(65.18%)of which were gram-negative bacteria;Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii were dominant among the pathogens and were highly resistant to ampicillin,ceftriaxone,ciprofloxacin and levofloxacin but were highly sensitive to meropenem and imipenem.31(27.68%)strains of gram-positive bacteria were isolated,Staphylococcus aureus and Staphylococcus epidermidis were the predominant species and were highly resistant to penicillin and erythromycin but were highly sensitive to vancomycin and teicoplanin.SHV,TEM,PER-1,qnrS and aac(6’)-2 were respectively detected in 1 strain of P.aeruginosa,there were 2 strains with CTX-M mutation and 2 strains with AmpC mutation.SHV,CTX-M,AmpC and qnrB mutations were respectively detected in 1 strain of K.pneumoniae and 1 strain of A.baumannii.tetM mutation was detected in 1 strain of K.pneumoniae,TEM,PER-1,qnrA and aac(6’)-2 mutations were respectively detected in 1 strain of A.baumannii,tetM and PBP1 a were respectively detected in 1 strain of S.aureus and 1 strain of S.epidermidis,and qnrA,aac(6’)-2,mecA and PBP2 b mutations were detected in 1 strain of S.aureus.CONCLUSION The pathogens isolated from the esophageal cancer patients who have pulmonary infection after radical resection are resistant to many kinds of drugs,and the mutations of drug resistance genes can be responsible for the resistance to some drugs.