血液内科住院老年肿瘤患者感染病原菌分布和耐药性分析研究

目的分析血液内科住院老年肿瘤患者感染病原菌的分布及耐药性。方法采集血液内科住院老年肿瘤患者血液标本117份,痰液80份。应用全自动血培养仪采样,API细菌鉴定系统进行病原菌检测及菌株鉴定,抗菌药物敏感性试验纸片进行药物敏感性试验。结果共分离出致病菌1513株,其中革兰氏阴性杆菌、革兰氏阳性球菌、真菌的数量及检出率分别为852株(56.3%)、283株(18.7%)和378株(25.0%)。革兰氏阴性杆菌主要以大肠埃希菌、铜绿假单胸菌和肺炎克雷伯菌为主,分别为220株(25.8%)、83株(9.7%)和62株(7.2%);真菌主要为白色念珠菌,检出率为8.6%。抗菌药物敏感性试验结果显示,革兰氏阴性杆菌对美罗培南、亚胺培南敏感度高,对氨苄西林、哌拉西林有很高的耐药性。结论血液内科老年肿瘤患者易发生院内感染,且容易产生耐药性,临床上应通过抗菌药物敏感性试验结果合理选择药物,以减少病原菌耐药性,提高临床治愈率。     

肿瘤患者院内下呼吸道细菌感染的病原菌分布及药物敏感性

目的 :研究我院住院恶性肿瘤患者的院内下呼吸道细菌感染病原菌的分布及药物敏感性。方法 :对1996年～ 2 0 0 0年间住我院并发院内下呼吸道感染的恶性肿瘤患者的 4 4 8份痰标本进行细菌学培养 ,阳性菌以K B法进行药敏试验。结果 :5年中分离出病原菌 333株 ,以革兰阴性菌为主 ,病菌检出率为 74 33%。革兰阴性菌以铜绿假单孢菌为主 (19 6 %～ 2 9.4 % ) ,革兰阳性菌以金黄色葡萄球菌为主 (12 .8%～ 2 4 7% ) ;药敏试验结果提示铜绿假单孢菌对第三代头孢菌素、三代氟喹诺酮、氨基糖甙类较为敏感 ,但对头孢曲松敏感性降低 (P <0 .0 5 ) ;金黄色葡萄球菌对万古霉素高度敏感 ,对苯唑西林的药物敏感性明显降低 ,由 4 5 5 %下降到 11 1% (P <0 .0 5 ) ,对头孢曲松敏感性亦降低 (P <0 .0 5 ) ;常用抗生素对肠杆菌属多有较高抗菌活性。结论 :我院住院肿瘤患者的院内下呼吸道感染以革兰阴性菌为主 ,但革兰阳性菌也是重要致病菌 ,应根据药敏试验结果选择抗生素 ,重视病原菌的分布及药物敏感性的变迁     

肿瘤患者院内下呼吸道细菌感染的病原菌分布及药物敏感性

目的：研究我院住院恶性肿瘤患者的院内下呼吸道细菌感染病原菌的分布及药物敏感性。方法：对1996年～2000年间住我院并发院内下呼吸道感染的恶性肿瘤患者的448份痰标本进行细菌学培养，阳性菌以K-B法进行药敏试验。结果：5年中分离出病原菌333株，以革兰阴性菌为主，病菌检出率为74.33％。革兰阴性菌以铜绿假单孢菌为主(19.6％～29.4％)，革兰阳性菌以金黄色葡萄球菌为主(12.8％～24.7％)；药敏试验结果提示铜绿假单孢菌对第三代头孢菌素、三代氟喹诺酮、氨基糖甙类较为敏感，但对头孢曲松敏感性降低(P＜0.05)；金黄色葡萄球菌对万古霉素高度敏感，对苯唑西林的药物敏感性明显降低，由45.5％下降到11.1％(P＜0.05)，对头孢曲松敏感性亦降低(P＜0.05)；常用抗生素对肠杆菌属多有较高抗菌活性。结论：我院住院肿瘤患者的院内下呼吸道感染以革兰阴性菌为主，但革兰阳性菌也是重要致病菌，应根据药敏试验结果选择抗生素，重视病原菌的分布及药物敏感性的变迁。     

老年中心型肺癌并发阻塞性肺炎的病原学特点及耐药性分析

目的:探讨老年中心型肺癌并发阻塞性肺炎的病原学特点及耐药性。方法:选自我院于2015年6月至2017年6月期间收治的老年中心型肺癌并发阻塞性肺炎患者61例,采集患者痰液标本,分离培养病原菌,分离鉴定病原菌及进行药敏试验。观察分离培养病原菌分布特点、主要革兰阴性菌对抗菌药物耐药情况、主要革兰阳性菌对抗菌药物耐药情况及治疗疗效。结果:61例老年中心型肺癌并发阻塞性肺炎患者分离培养病原菌72株,其中革兰阴性菌41株、革兰阳性菌28株、真菌3株。肺炎克雷伯菌对左氧氟沙星和头孢曲松耐药率较高,分别为93.75%和87.50%;铜绿假单胞菌对头孢哌酮和美罗培南耐药率较高,分别为92.86%和85.71%。金黄色葡萄球菌对青霉素G和红霉素耐药率较高,分别为100.00%和90.91%;表皮葡萄球菌对青霉素G和红霉素耐药率较高,分别为100.00%和80.00%。结论:老年中心型肺癌并发阻塞性肺炎的病原学以革兰阴性菌为主,主要革兰阴性菌对左氧氟沙星、头孢曲松、头孢哌酮和美罗培南耐药率较高,主要革兰阳性菌对青霉素G和红霉素耐药率较高,具有重要研究意义,值得推广应用。     

肿瘤患者院内下呼吸道感染病原菌分布及耐药性分析

目的了解肿瘤患者院内下呼吸道感染病原菌分布及耐药情况。方法回顾性分析326例住院肿瘤患者下呼吸道感染痰细菌分离株及耐药监测情况。结果共分离细菌342株，其中革兰阴性菌占53．2％，以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为多见；革兰阳性菌占18．7％，主要是金黄色葡萄球菌；真菌占28．1％；培养出2种致病菌的患者占48．6％，其中革兰阴性菌合并真菌感染占混合感染的65．4％。致病菌对常用抗生素都不同程度地产生了耐药性，对青霉素、氨苄西林耐药率最高，对亚胺培南／西司他丁的耐药率最低，未发现对万古霉素耐药的金黄色葡萄球菌。结论肿瘤患者院内下呼吸道感染的主要病原菌为革兰阴性菌，细菌耐药性严重，并且具有多重耐药性。治疗时应重视病原菌培养和药物敏感试验，合理使用抗生素。     

老年中心型肺癌并发阻塞性肺炎的病原菌分布及耐药性监测

目的:研究老年中心型肺癌并发阻塞性肺炎的病原菌分布及耐药性监测。方法:选自我院于2015年11月至2017年11月期间收治的老年中心型肺癌并发阻塞性肺炎患者122例作为观察对象。分离、培养、鉴定患者病原菌并进行药敏试验。观察病原菌分布特点、主要革兰阳性菌及革兰阴性菌对抗菌药物耐药情况。结果:122例老年中心型肺癌并发阻塞性肺炎患者共分离培养病原菌144株,其中革兰阳性菌56株、革兰阴性菌82株、真菌6株。表皮葡萄球菌对红霉素及青霉素G耐药率较高,分别为80.0%和100.0%;金黄色葡萄球菌对红霉素及青霉素G耐药率较高,分别为90.9%和100.0%。铜绿假单胞菌对美罗培南及头孢哌酮耐药率较高,分别为85.7%和92.9%;肺炎克雷伯菌对头孢曲松及左氧氟沙星耐药率较高,分别为87.5%和93.8%。结论:老年中心型肺癌并发阻塞性肺炎的病原菌分布以革兰阴性菌为主,且对部分抗菌药物耐药明显,值得临床上注意。     

老年肺癌放化疗前后肺部感染的病原菌培养及药敏分析

目的 探讨老年肺癌放化疗前后肺部感染的病原菌感染情况以及药敏分析结果 .方法 收集进行放化疗的老年肺癌患者97例作为研究对象,对其病原菌培养结果 及药敏分析结果 进行回顾性分析.结果 97例患者放化疗前共分离出病原菌85株,其中革兰阴性菌67.06%,革兰阳性菌8.24%,真菌24.71%;放化疗后共分离出病原菌110株,其中革兰阴性菌55.45%,革兰阳性菌6.36%,真菌38.18%.治疗后真菌所占比例明显高于放化疗前,差异有统计学意义(P<0.05).放化疗后铜绿假单胞菌对亚胺培南耐药率显著升高,较放化疗前差异有统计学意义(P<0.05),而对其他药物耐药率无统计学差异(P>0.05).放化疗前后肺炎克雷伯菌对各药物耐药率均无统计学差异(P>0.05).放化疗前白色念珠菌对几种药物耐药率均较低,放化疗后,氟康唑、氟胞嘧啶耐药率较放化疗前略升高,但差异无统计学意义(P>0.05).结论 放化疗后老年肺癌患者真菌感染率增高,对于大部分患者耐药率影响不显著.     

血液肿瘤患者化疗后院内血行感染细菌分布特点及药敏分析

 目的　了解血液肿瘤化疗患者院内血行感染细菌分布特点及药物敏感性。方法　采用Kirby-Bauer法进行药敏试验,分析血液中分离得到的56株细菌。结果　革兰阴性菌（G-）占69.64 ％,革兰阳性菌（G+）占30.36 %。以大肠埃希菌最为常见（37.50 ％）,其次为肺炎克雷伯菌（10.71 ％）。葡萄球菌全部为耐甲氧西林葡萄球菌,仅对万古霉素敏感。结论　血液肿瘤化疗患者院内血行感染仍以G-菌为主;大肠埃希菌最常见;葡萄球菌全部为耐甲氧西林葡萄球菌,仅对万古霉素100 %敏感。     

老年卵巢癌患者术后尿路感染常见病原菌分析及药敏实验

目的 调查与分析老年卵巢癌患者术后尿路感染常见病原菌及药敏实验结果 .方法 选取68例老年卵巢癌术后尿路感染患者为研究对象,对其尿液病原菌检出情况进行分析与比较,并对病原菌的药敏实验结果 进行分析与比较.结果 68例老年卵巢癌术后尿路感染患者共检出75株病原菌,其中革兰阴性菌检出率明显高于革兰阳性菌及真菌的检出率,革兰阳性菌检出率则显著高于真菌的检出率,革兰阴性菌对氨苄西林、哌拉西林及环丙沙星的耐药率显著高于对其他药物的耐药率,革兰阳性菌对青霉素、红霉素及苯唑西林的耐药率显著高于对其他药物的耐药率,差异均有统计学意义(P均<0.05).结论 老年卵巢癌患者术后尿路感染常见病原菌为革兰阴性菌,且革兰阴性菌及革兰阳性菌对常规抗菌药物的耐药性均较为突出,应针对其病原菌分布及耐药性情况给予针对性干预.     

肿瘤医院病原菌的分布及耐药分析

目的 了解肿瘤患者医院感染的病原菌分布及其耐药特征.方法 对山西省肿瘤医院2009年1月至2011年12月肿瘤患者医院感染的病原菌及耐药情况进行统计分析.结果 共检出病原菌6347株,其中革兰阴性菌3737株,占58.9％,真菌1907株,占30.0％,革兰阳性菌703株,占11.1％.主要病原菌是大肠埃希菌、白假丝酵母菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌.大肠埃希菌对青霉素类、头孢呋辛、头孢噻肟和喹诺酮类的药物耐药明显,耐药率在60.0％以上,铜绿假单胞菌对亚胺培南和美洛培南的耐药率达到32.7％和30.5％.结论 肿瘤医院患者院内感染的病原菌及耐药特征与其他医院感染有所不同,以呼吸道感染条件致病菌为主.     

老年肺癌患者化疗后肺部感染的病原菌分布及其对免疫功能的影响

目的:探讨老年肺癌患者化疗后肺部感染的病原菌分布及其对免疫功能的影响。方法:选取我院于2015年1月至2018年1月收治的老年肺癌化疗患者183例,分析化疗后肺部感染病原菌和耐药性、肺部感染与未感染患者免疫功能指标变化。结果:肺癌患者化疗后发生肺部感染82例,发生率为44.81%;共分离培养病原菌93株,革兰阴性菌59株、革兰阳性菌30株、真菌4株,革兰阴性菌中,主要为铜绿假单胞菌27株、肺炎克雷伯菌13株;革兰阳性菌中,主要为金黄色葡萄球菌11株、凝固酶阴性葡萄球菌10株。主要革兰阴性菌中,铜绿假单胞菌对头孢哌酮和头孢他啶耐药率较高,分别为92.59%和85.18%;肺炎克雷伯菌对头孢吡肟和头孢他啶耐药率较高,分别为84.61%和76.92%。主要革兰阳性菌中,金黄色葡萄球菌对青霉素G和红霉素耐药率较高,分别为90.91%和81.82%;凝固酶阴性葡萄球菌对红霉素和青霉素G耐药率较高,分别为100.00%和80.00%。肺部感染组CD3+、CD4+和CD4+/CD8+低于未感染组,有统计学差异（P＜0.05）。结论:老年肺癌患者化疗后肺部感染的病原菌分布主要为革兰阴性菌,主要革兰阴性菌对头孢类耐药率较高,主要革兰阳性菌对青霉素和红霉素耐药率较高,且肺部感染患者免疫功能明显下降。     

Analysis of pathogen distribution and drug resistance of nosocomial infections accompanied in patients with malignant tumor

Objective:To investigate the pathogen distribution and drug resistance of nosocomial infections accompanied in patients with malignant tumor.Methods:The pathogen culture and drug-sensitivity data of 107 specimens isolated from malignant tumor patients accompanied with nosocomial infection were retrospectively analyzed.Results:Among 118 strains of pathogens isolated from 107 specimens,77 were gram-negative bacillus(65.3%),26 were gram-positive coccus(65.3%),and 15 were fungus(12.7%).Eleven specimens were revealed to have combined infection of bacterium and fungus.Gram-negative bacillus showed high sensitivity to amikacin,ciprofloxacin,and tienam.Gram-positive cocci were highly sensitive to tienam and vancomycin.The bacteria were resistant to other antibiotics in different degrees.Vancomycin-resistant staphylococcus was not detected.Candida was sensitive to antifungals.Conclusion:Conditional pathogenic bacteria were mainly responsible for nosocomial infections in malignant tumor patients with considerable drug resistance.This shows that bacterial tests and the rational use of antibiotics should be emphasized in clinical practice to prevent the formation of drug resistant strains and further endogenous infections.     

晚期肺癌伴下呼吸道感染的临床分析

目的：探讨晚期肺癌患者发生肺部感染的病原菌及药敏情况。方法：采用回顾性调查方法,分析１９０例晚期肺癌患者肺部感染、痰菌培养及药敏试验的临床资料。结果：培养出病原菌２５２株,其中真菌４９株,细菌２０３株;细菌中革兰氏阴性菌占６５.５％,革兰氏阳性菌占３４.５％。革兰氏阴性菌主要为大肠杆菌、非发酵菌属、铜绿假单胞菌、肺炎克雷伯菌;革兰氏阳性菌主要为粪肠球菌、表皮葡萄球菌、溶血葡萄球菌。革兰氏阴性菌主要对氨基糖甙类、喹诺酮类、碳青霉烯类敏感;革兰氏阳性菌主要对万古霉素敏感。抗真菌治疗主要用氟康唑或伏立康唑。结论：肺癌患者肺部感染多为革兰氏阴性菌感染,混合性感染以及二重感染比例较高;各种致病菌对常用抗生素存在着不同程度耐药性,临床医生应根据药敏试验结果合理使用抗生素。     

老年NSCLC放化疗患者医院感染致病菌的耐药性筛查及对策研究

目的 研究老年非小细胞肺癌(NSCLC)放化疗患者医院感染致病菌的耐药性及对策.方法 选取老年NSCLC放化疗者618例,重点监测医院感染者致病菌分布、耐药性.根据耐药性筛查结果 ,总结相应对策.结果医院感染149例,感染率24.11％,其中呼吸道感染构成比78.52％,高于泌尿道10.74％、胃肠道9.40％,差异有...     

A retrospective study of risk and prognostic factors in relation to lower respiratory tract infection in elderly lung cancer patients

Lung cancer (LCa) is one of the most common and deadly malignancies in elderly patients. During the course of the disease, these patients frequently present with lower respiratory tract infection. Therefore, this study aims to investigate the clinical features of lower respiratory tract infection in elderly LCa patients and evaluate the impact on overall survival rate. Clinical and laboratory data were analyzed retrospectively for a total of 1936 patients that were over 60-years-old. Patients were classified into three groups based on pulmonary diseases: Group 1, lung cancer (LCa); Group 2, chronic obstructive pulmonary disease (COPD); and Group 3, other medical diseases without pulmonary problems (OMD). Univariate and multivariate analysis were used to evaluate related risk factors of infections and prognostic factors. The infection rate of the LCa group (46.25%) was significantly higher than the COPD (31.40%) and OMD (23.33%) groups. Polymicrobial infections were most prevalent in the LCa group (28.75%), which far exceeded the prevalence in COPD (11.05%) and OMD (4.44%) groups. In LCa patients, the most frequent pathogens were Gram-negative bacteria (44.87%), followed by fungi (34.62%) and Gram-positive bacteria (20.51%), the major pattern of polymicrobial infections was mixed Gram-negative bacteria and fungi (43.48%). Multivariate analysis revealed that COPD, pleural effusion, anatomical type, low cellular immune function, and length of hospital stay were related risk factors of lower respiratory tract infection in elderly LCa patients. A multivariate Cox proportional hazards regression model revealed that age, stage of TNM, surgical resection, antitumor therapy, lower respiratory tract infection, COPD, and pleural effusion were independent prognostic factors for cancer-related death. Patients who received effective antimicrobial treatment had a better outcome than those who did not respond to antimicrobial drugs (HR = 0.458, P < 0.05). Understanding lower respiratory tract infection in elderly LCa patients is vital if we are to set up corresponding measures and to target effective antimicrobial treatment.     

A study of bacteremia in febrile neutropenic patients at a tertiary-care hospital with special reference to anaerobes

Patients with hematological malignancies who are receiving chemotherapy suffer prolonged periods of neutropenia, which leads to a greater risk of infection and mortality. A prospective study was conduced to determine the incidence of bacteremia in patients of hematological malignancies over a 2-yr period. A total of 119 episodes of febrile neutropenia occurred among 96 consecutive patients, of which 35 episodes were associated with bacteremia. Forty-four percent of the isolated bacteria were Gram-positive aerobes and 46% were Gram-negative aerobes. Staphylococcus aureus, Enterococcus spp., and Escherichia coli were the most common isolates. Gram-negative bacteremia was associated with a higher mortality. Anaerobes accounted for 4.4% of all isolates. The episodes of anaerobic bacteremia were polymicrobial and had a fatal outcome. A high incidence of antimicrobial resistance among aerobic and anaerobic bacteria was also recorded. Compared to previous years, a shift from a predominating Gram-negative to a Gram-positive etiology was noted. The initial empiric antibiotic regimens should be based on a local knowledge of the most common causative microorganisms, their sensitivity pattern, and the outcome of bacteremia.     

Bacterial Spectrum and Antimicrobial Resistance Pattern in Cancer Patients with Febrile Neutropenia

Background: Bacterial bloodstream infections are one of the most common complications in cancer patients undertreatment. Bacteremia in these patients is a medical crisis that needs antibiotic treatment. The aim of this study wasto determine bacterial spectrum and antimicrobial resistance pattern in febrile neutropenic cancer patients. Methods:In this prospective study, 212 cancer patients with febrile neutropenia who were referred to Shahid Sadoughi hospitalin Yazd from 2012 to 2015 were participated. Bacterial pathogens isolated by the BACTEC media and antimicrobialsusceptibility tests performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results:The mean age of patients was 43.5 ± 24.98 years old. Out of 212 participants, 62.3℅ (132/212) were suffering fromhematologic malignancies, and 37.7℅ (80/212) had solid tumors. Gram-negative bacteria were the predominantmicroorganisms (84.9℅). E.coli was the most frequently isolated pathogen (38.68 %), followed by Klebsiella(14.15℅) and Acinetobacter species (11.32℅). In addition, Staphylococcus epidermidis was the most common isolatedGram-positive bacteria (8.5℅). Gram-negative bacteria were susceptible to ciprofloxacin with a response range of 53.7%to 100%. The majority of E.coli isolates were sensitive to ceftazidime (87.8℅) and were resistance to Co-trimoxazole(15.8℅). Klebsiella isolates were 100% susceptible to cephalosporins, meropenem and imipenem. Conclusion: Themajority of bacterial pathogens were resistance to various antibiotics. Judicious use of antibiotic therapy can preventthe emergence and spread of antibiotic-resistant Gram-negative bacteria.     

消化系统肿瘤患者术后真菌感染病原菌分布及耐药性分析

目的 分析消化系统肿瘤患者术后真菌感染病原菌分布特点及耐药情况,从而为临床预防和诊治提供依据.方法 随机选取消化系统肿瘤术后患者1000例为调查对象,其中合并真菌感染患者91例,感染率为9.1％.收集标本,对检出的病原菌进行菌属鉴定,同时进行药敏试验.结果 年龄、远处转移以及肿瘤分期是影响肿瘤患者术后真菌感染的因素(P＜0.05).91例感染患者中,呼吸系统感染72例,占79.12％,消化系统感染17例,占18.68％,泌尿系统感染3例,占3.30％;91株真菌中,白色假丝酵母-菌59株,占64.84％,热带假丝酵母菌12株,占13.19％,光滑假丝酵母菌11株,占12.09％,克柔假丝酵母菌7株,占7.69％,其他2株,占2.20％;91例患者中,合并细菌二重感染58例,占63.74％.以革兰阴性菌为主,占94.83％,其中包括肺炎克雷伯菌、鲍氏不动杆菌、大肠埃希菌、铜绿假单胞菌等.合并革兰阳性菌占5.17％,为葡萄球菌属;白色假丝酵母菌、热带假丝酵母菌、光滑假丝酵母菌以及克柔假丝酵母菌对两性霉素、伏立康唑耐药性为0,对氟康唑和氟康唑有较低耐药率.结论 消化系统肿瘤术后患者真菌感染以白色假丝酵母菌为主,且多合并细菌感染,以革兰阴性菌为主,好发部位为呼吸道,临床上应根据药敏试验结果采取有效的药物治疗.