肝癌切除术后肺部感染致病菌及耐药性分析

Analysis of pulmonary infection,pathogenic bacteria and drug resistance after liver cancer resection

目的 对肝癌切除后肺部感染状况与致病菌及耐药性进行分析研究。方法 选择2019年1月至2021年12月于郑州大学第一附属医院进行肝癌切除术的患者208例,其中开腹半肝切除术59例,开腹肝切除术41例,腹腔镜肝癌切除术96例、腹腔镜半肝切除12例,共有15例患者肺部感染,采集所有肝癌切除术患者的呼吸道标本(痰液、咽拭子)、腹水、胸腔积液、血液、胆汁、中段尿作为标本,将采集到的标本送往细菌培养和药敏实验,应用RT-PCR技术检验引发肺部感染的病菌的种类和分布。结果 本次实验致病菌共培养出46株菌株,对病原菌分布进行研究分析,革兰氏阴性菌有28株,占比60.87%,其中大肠埃希菌和肺炎克雷布菌比例较高,分别为32.61%和15.22%,革兰氏阳性菌共17株,占比36.96%,其中肠球菌和葡萄球菌、肺炎链球菌的比例较大,分别为19.57%、6.52%、8.70%,真菌较少,仅为1株,占比2.17%。对主要革兰氏阴性菌进行药敏性检验,发现亚胺培南和头孢唑林的敏感度最高,头孢唑林的敏感度均为100%,亚胺培南对大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌的敏感度分别为93.33%、85.71%、100%。对革兰氏阳性菌进行药敏性检验发现,万古霉素、利奈唑胺、青霉素G对革兰氏阳性菌的敏感度较高,其中利奈唑胺和青霉素G的敏感度均为100%,万古霉素的敏感度分别为肠球菌、葡萄杆菌、肺炎链球菌88.89%、66.67%、75.00%。由于真菌的数量较少,对其进行药敏性检验结果不具有代表性,故不对针具进行药敏性检验。结论 万古霉素、利奈唑胺和青霉素G对有革兰氏菌阳性菌引发的肺部感染有十分显著的效果,但由于利奈唑胺的成本和不良反应较大、青霉素G成本较高,因此建议应用万古霉素治疗由革兰氏阳性菌引发的肺部感染,亚胺培南对治疗革兰氏阴性菌引发的肺部感染有显著的效果,建议临床分清引发肺部感染的菌种是阴性还是阳性后再进行针对性的药物治疗。

Objective To analyze the status of pulmonary infection,pathogenic bacteria and drug resistance after liver cancer resection.Methods A total of 208 patients who underwent liver cancer resection in our hospital from From January 2019 to December 2021 were selected,among which 49 patients received hemihepatectomy,46 patients underwent hepatectomy for hepatocellular carcinoma,and 9 patients under laparoscopic hemihepatectomy.In patients with lung infection,respiratory specimens(sputum,throat swab),ascites,pleural effusion,blood,bile,and midstream urine were collected from all patients undergoing liver cancer resection.The collected specimens were sent to bacterial culture and susceptibility testing.The use of RT-PCR technology to detect the type and distribution of pathogens that cause lung infections.Results A total of 46 strains were co-cultured in this experiment and the distribution of pathogenic bacteria was studied and analyzed.There were 28 strains of Gram-negative bacteria,accounting for 60.87%,of which the proportion of Escherichia coli and Klebsiella pneumoniae was high.There were 32.61% and 15.22% respectively,and there were 17 Gram-positive bacteria,accounting for 36.96%.Among them,the proportions of Enterococcus and Staphylococcus and Streptococcus pneumoniae were larger,19.57%,6.52%,and 8.70%,respectively.Fungus,only 1 strain,accounting for 2.17%.The susceptibility testing of the major gram-negative bacteria gold showed that the sensitivity of imipenem and cefazolin was the highest,the sensitivity of cefazolin was 100%,the sensitivity of imipenem were 93.33% 85.71%,100%.The susceptibility testing of gram-positive bacteria showed that vancomycin,linezolid,and penicillin G were more sensitive to gram-positive bacteria,and the sensitivity of linezolid and penicillin G was 100%.The sensitivity of vancomycin were 88.89%,66.67%,and 75.00%,respectively.Due to the small number of fungi,the susceptibility test results are not representative,so the susceptibility testing of needles was not performed.Conclusion Vancomycin,linezolid,and penicillin G have very significant effects on lung infections caused by gram-positive bacteria.However,due to the cost and side effects of linezolid,and the high cost of penicillin G,it is recommended that Vancomycin is used to treat lung infections caused by gram-positive bacteria.Imipenem has a significant effect on the treatment of lung infections caused by gram-negative bacteria.Clinically,it is recommended to distinguish the bacteria that cause lung infections.Negative or positive followed by targeted drug treatment.