肺癌术后合并院内肺部感染的病原菌特点及多重耐药性分析

摘要/Abstract

摘要： 目的：分析肺癌术后合并院内肺部感染患者的病原菌分布及其耐药性特点。方法：选取2017年3月至2020年3月收治的246例肺癌术后合并院内肺部感染患者作为研究对象，收集并记录患者肺部感染情况、病原菌分布情况以及主要革兰氏阳性菌、革兰氏阴性菌、真菌对抗菌药物的耐药性。结果： 246例患者痰液标本共检出309株病原菌，其中革兰氏阴性菌189株（61.17%），尤以大肠埃希菌（59株）检出率（19.09%）最高；革兰氏阳性菌91株（29.45%），尤以金黄色葡萄球菌（33株）检出率（10.68%）最高；真菌29株（9.39%），尤以白色念珠菌（16株）检出率（5.18%）最高；大肠埃希菌、铜绿假单胞菌等主要革兰氏阴性菌对头孢吡肟、头孢唑林、氨苄西林、复方新诺明具有较高的耐药性，对头孢他啶、头孢哌酮、阿米卡星、亚胺培南具有较高敏感性；金黄色葡萄球菌、溶血性葡萄球菌等主要革兰氏阳性菌对大部分药物均具有较高耐药性，对四环素敏感性较高，对万古霉素无耐药性；白色念珠菌、热带念珠菌、光滑念珠菌除对酮康唑与伏立康唑均较敏感外，对其他药物耐药性不一。结论：肺癌术后合并院内肺部感染患者尤以大肠埃希菌为主的革兰氏阴性菌感染率最高，且除对头孢他啶、头孢哌酮敏感性较高外，对大部分抗菌药物均具有较高耐药性，临床上应针对病原菌感染特点合理选用抗菌药物抗感染治疗。

关键词: font-size:medium, ">肺癌；肺部感染；病原菌；大肠埃希菌；金黄色葡萄球菌；白色念珠菌；耐药性

Abstract: Objective： To analyze the distribution and drug resistance of pathogenic bacteria in patients with nosocomial pulmonary infection after lung cancer surgery. Methods： A total of 246 patients with nosocomial pulmonary infection after lung cancer surgery from March 2017 to March 2020 were selected as the research objects. The pulmonary infection status，distribution of pathogenic bacteria， major gram-positive bacteria，gram-negative bacteria and fungal resistance to antimicrobial agents were collected and recorded. Results：A total of 309 strains of pathogenic bacteria were detected in the sputum samples of 246 patients， among which 189 (61.17%) were gram-negative bacteria. Escherichia coli (59 strains) had the highest detection rate (19.09%). There were 91 gram-positive bacteria (29.45%)， and staphylococcus aureus (33 strains) had the highest detection rate (10.68%). There were 29 fungus（9.39%）. The detection rate of candida albicans (16 strains) was the highest (5.18%). Escherichia coli，Pseudomonas aeruginosa and other major gram-negative bacteria showed high resistance to cefepime，cefazolin，ampicillin and cotrimoxazole，and high sensitivity to ceftazidime，cefoperazone，amikacin and imipenem. Major gram-positive bacteria，such as Staphylococcus aureus and Staphylococcus hemolyticus，have high resistance to most drugs，high sensitivity to tetracycline，and no resistance to vancomycin. Candida albicans，candida tropicalis and Candida glabrata were sensitive ketoconazole and voriconazole and resistance to other drugs were various. Conclusion： After lung cancer surgery，patients with nosocomial pulmonary infection， for gram-negative bacteria especially escherichia coli，had the highest rate of infection and except for ceftazidime and cefoperazone，they were highly resistant to most antimicrobial agents. Therefore，antimicrobial agents should be used for anti-infective treatment in clinical practice according to the characteristics of pathogenic bacteria infection.

Key words: font-size:medium, ">Lung cancer； Pulmonary infection； Pathogenic bacteria； Escherichia coli； Staphylococcus aureus； Candida albicans； Drug resistance

中图分类号:

徐彪, 沙纪名, 赵旭东, 曹炜, 周晓, 吴君旭, 徐盛松. 肺癌术后合并院内肺部感染的病原菌特点及多重耐药性分析[J]. 中国医药导刊, 2021, 23(4): 247-250.

XU Biao, SHA Jiming, ZHAO Xudong, CAO Wei, ZHOU Xiao, WU Junxu, XU Shengsong. Analysis of Pathogen Characteristics and Multi-drug Resistance of Nosocomial Pulmonary Infection after Lung Cancer Operation[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(4): 247-250.

参考文献

[1]石晶，魏栋，储云茜，等.肺癌脑转移治疗现状[J]. 中国神经精神疾病杂志，2019，45(11)：701-704.
     [2]Boer BC， de Graaff F， Brusse-Keizer M， et al. Skeletal muscle mass and quality as risk factors for postoperative outcome after open colon resection for cancer[J]. Int J Colorectal Dis， 2016， 31(6)：1117-1124.
     [3]叶霖.肺癌合并肺部真菌感染的诊疗进展[J]. 临床与病理杂志，2017，37(8)：1737-1741.
     [4]Gowing SD， Chow SC， Cools-Lartigue JJ， et al. Gram-positive pneumonia augments non-small cell lung cancer metastasis via host toll-like receptor 2 activation[J]. Int J Cancer， 2017， 141(3)：561-571.
     [5]诸君，赵丹妹，陈建国，等.肺癌患者化疗后肺部感染病原菌分布与耐药性分析[J]. 检验医学与临床，2017，14(21)：3170-3172.
     [6]姚逸临.疏肝肺积方结合心理干预对原发性肺癌患者生存质量的影响[J]. 中国肺癌杂志，2012，15(1)：27-33.
     [7]中华人民共和国卫生部医政司.全国临床检验操作规程[M]. 3版.南京：东南大学出版社，2006：715-920.
     [8]Clinical and Laboratory Standards Institute.M100 S23 performance standards for abtimicrobial susceptibility testing；twenty-third informational supplement[S]. Wayne， PA：CLSI， 2013.
     [9]Cao M，Chen W.Epidemiology of lung cancer in China[J]. Thorac Cancer，2019，10(1)：3-7.
     [10]王鹏，张东，郭学光，等.老年非小细胞肺癌患者肺部感染病原学分布与耐药性分析[J]. 现代生物医学进展，2017，17(32)：6260-6266.
     [11]Okada S， Shimada J， Teramukai S， et al.Risk stratification according to the prognostic nutritional index for predicting postoperative complications after lung cancer surgery[J]. Ann Surg Oncol， 2018， 25(5)：1254-1261.
     [12]唐景云，秦晓林.ESBLs在大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌中的检出率及耐药情况比较[J]. 中国医药科学，2016，6(3)：175-178.
     [13]刘萍，候应龙，孙淑娟.联合用药对白色念珠菌-金黄色葡萄球菌混合生物膜的作用及其影响因素[J]. 中国医院药学杂志，2014，34(3)：170-175.
     [14]李峥.亚甲基蓝介导的光动力疗法对白色念珠菌及金黄色葡萄球菌的杀伤作用[D]. 广西：广西医科大学，2019.
     [15]Boffa DJ， Kosinski AS， Furnary AP， et al. Minimally invasive lung cancer surgery performed by thoracic surgeons as effective as thoracotomy[J]. J Clin Oncol， 2018， 36(23)：2378-2385.
     [16]Curran T， Alvarez D， Pastrana Del Valle J， et al. Prophylactic closed-incision negative-pressure wound therapy is associated with decreased surgical site infection in high-risk colorectal surgery laparotomy wounds[J]. Colorectal Dis， 2019， 21(1)：110-118.
     [17]Epshelovich D， Goldvaser H， Edel Y， et al. High lung cancer incidence in heavy smokers following hospitalization due to pneumonia[J]. Am J Med， 2016， 129(3)：332-338.
     [18]Paul M， Carmeli Y， Durante-Mangoni E， et al. Combination therapy for carbapenem-resistant gram-negative bacteria[J]. J Antimicrob Chemother， 2014， 69(9)：2305-2309.

快速检索引用检索图表检索高级检索