肺癌化疗患者肺部感染病原学及肺炎克雷伯菌分离株耐药基因

Etiological characteristics of pulmonary infection in lung cancer patients undergoing chemotherapy and drug resistance genes in Klebsiella pneumoniae isolates

目的分析肺癌化疗患者肺部感染(PI)病原学特点及肺炎克雷伯菌分离株的耐药基因。方法分析2019年4月—2023年1月在金华市中心医院接受治疗的104例肺癌化疗合并PI患者分离病原菌分布特点、主要病原菌耐药情况及肺炎克雷伯菌分离株耐药基因携带情况。结果肺癌化疗合并PI患者呼吸道分泌物标本共分离病原菌111珠,其中革兰阳性菌25株占比22.52%、革兰阴性菌71株占比63.96%、真菌15株占比13.51%;主要革兰阴性菌中肺炎克雷伯菌对头孢吡肟、头孢唑林、氨苄西林/舒巴坦钠的耐药率较高,耐药率分别为81.48%、62.96%、81.48%,铜绿假单胞菌对头孢吡肟、头孢唑林、头孢曲松和氨苄西林/舒巴坦钠的耐药率较高,耐药率分别为65.00%、60.00%、50.00%和75.00%,大肠埃希菌对头孢吡肟、头孢唑林、氨苄西林/舒巴坦钠和庆大霉素的耐药率较高,耐药率分别为61.54%、76.92%、61.54%和53.58%;27株肺炎克雷伯菌中TEM-1、CTX-M-8、SHV-12耐药基因携带率较高。结论肺癌化疗合并PI患者病原菌中占比最高的为革兰阴性菌,主要为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌,且不同致病菌存在不同的耐药现象,肺炎克雷伯菌耐药基因主要为TEM-1、CTX-M-8、SHV-12,临床可根据病原菌培养与耐药分析结果选用合适的抗菌药物。

OBJECTIVE To analyze the etiological characteristics of pulmonary infection(PI)in the lung cancer pa-tients undergoing chemotherapy and observe the drug resistance genes in the Klebsiella pneumoniae isolates.METHODS Totally 104 lung cancer patients who received chemotherapy in Jinhua Central Hospital and were com-plicated with PI from Apr 2019 to Jan 2023 were enrolled in the study.The distribution of isolated pathogens,drug resistance rates of major species of pathogens and drug resistance genes in K.pneumoniae isolates were ob-served.RESULTS Totally 111 strains of pathogens were isolated from respiratory tract secretions of the lung canc-er patients complicated with PI,25(22.52%)of which were gram-positive bacteria,71(6.96%)were gram-neg-ative bacteria,and 15(13.51%)were fungi.Among the major species of gram-negative bacteria,the drug resist-ance rates of the K.pneumoniae strains to cefepime,cefazolin and ampicillin-sulbactam were 81.48%,62.96%and 81.48%,respectively;the drug resistance rates of Pseudomonas aeruginosa strains to cefepime,cefazolin,ceftriaxone and ampicillin-sulbactam were 65.00%,60.00%,50.00%and 75.00%,respectively;the drug re-sistance rates of Escherichia coli strains to cefepime,cefazolin,ampicillin-sulbactam and gentamycin were 61.54%,76.92%,61.54%and 53.58%,respectively.Among the 27 strains of K.pneumoniae,the carrying rates of drug resistance genes TEM-1,CTX-M-8 and SHV-12 were relatively high.CONCLUSION The gram-neg-ative bacteria are dominant among the pathogens isolated from the lung cancer patients complicated with PI;K.pneumoniae,P.aeruginosa and E.coli are the predominant species and vary in the drug resist-ance.TEM-1,CTX-M-8and SHV-12 are the major drug resistance genes carried by the K.pneumoniae.It is necessary for the hospital to reasonably use antibiotics based on the results of bacterial culture and drug suscep-tibility testing.