住院肺肿瘤患者痰液病原菌分布及药物敏感性分析

目的：分析住院肺肿瘤患者痰液病原菌的分布及耐药性，为临床合理用药提供参考。方法：收集2009-2013年浦南医院肺肿瘤住院患者痰标本618份，分离病原菌，并对其分布及耐药情况进行回顾性分析。结果：618份标本中检出病原菌689株，其中革兰阴性菌429株，占62.3%，主要为铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌；革兰阳性菌140株，占20.3%，以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主；真菌120株，占17.4%，主要为白色假丝酵母。不同菌属对抗生素的耐药率有差别，铜绿假单胞菌对亚胺培南、头孢哌酮/舒巴坦耐药率相对较低。肺炎克雷伯菌和大肠埃希菌对碳青霉烯类抗菌药物有较高的敏感性，但对青霉素类和头孢呋辛有较高的耐药性。革兰阳性球菌对万古霉素和替考拉宁的敏感性较高。结论：住院肺肿瘤患者痰液病原菌以革兰阴性菌为主，且主要的致病菌对常用抗菌药物耐药严重，需要对病原菌的分布变化及耐药性给予高度重视，以指导临床进行合理规范的抗感染治疗。

Analysis of the distribution of the sputum pathogens and the drug sensitivity of inpatients with the pulmonary tumor

Objective：To analyze the distribution of the sputum pathogens and the drug resistance of in-patients with the pulmonary tumor to provide the reference for the clinical reasonable application of drugs. Methods： Six hundred and eighteen sputum specimens from the in-patients with the pulmonary tumor in Punan Hospital from 2009-2013 were collected. The pathogens were isolated, and their distribution and drug resistance were retrospectively analyzed. Results： Six hundred and eightynine strains of pathogens were isolated from 618 sputum specimens. In 429 （62.3%） strains of gram-negative bacilli, Pseudomonas aeruginosa, Klebsiella pneumonia and Escherichia coli were dominant. In 140 （20.3%） stains of gram-positive bacilli, coagulasenegative staphylococci and staphylococcus aureus were dominant. In 120 （17.4%） stains of fungi, Candida albicans was dominant. The rates of the resistance to antimicrobial agents were different among bacteria. The Pseudomonas aeruginosa had the relatively low drug resistance to imipenem, cefoperazone and sulbactam. The Klebsiella pneumoniae and Escherichia coli kept the high sensibility to imipenem and meropenem, but had a high resistance to penicillins and cefuroxime. The gram-positive cocci had a high sensitivity to teicoplanin and vancomycin. Conclusion：The sputum pathogens in the inpatients with the pulmonary tumor are mainly the gramnegative bacilli, and the main pathogens had the serious drug resistance to the commonly used antibiotics. It should be paid higher attention to the pathogen distribution and their drug resistance.The instruction of the reasonable and standardized antiinfective treatment should be given to the clinician.