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。

The distribution of pathogenic bacteria in lung infection after chemotherapy in elderly patients with lung cancer and its effect on immune function

Objective:To investigate the distribution of pathogenic bacteria in lung infection after chemotherapy in elderly patients with lung cancer and its effect on immune function.Methods:183 patients with lung cancer chemotherapy were selected from January 2015 to January 2018 in our hospital.The analysis of pulmonary infection,pathogenic bacteria and drug resistance of lung infection,and the changes of immune function indexes in patients with lung infection and uninfected.Results:82 cases of lung infection occurred in lung cancer patients after chemotherapy,and the incidence of lung infection was 44.81%.93 strains of pathogenic bacteria were isolated and cultured in 82 cases of pulmonary infection,including 59 Gram-negative bacteria,30 Gram-positive bacteria and 4 fungi.Gram-negative bacteria were mainly 27 strains of Pseudomonas aeruginosa and 13 strains of Klebsiella pneumoniae.Gram-positive bacteria were mainly Staphylococcus aureus 11 strains and coagulase negative Staphylococci 10 strains.Among the main Gram-negative bacteria,Pseudomonas aeruginosa had higher resistance rates to cefoperazone and ceftazidime,92.59% and 85.18% respectively,and the resistance rates of Klebsiella pneumoniae to cefepime and ceftazidime were 84.61% and 76.92%,respectively.Among the main Gram-positive bacteria,Staphylococcus aureus had higher resistance rates to penicillin G and erythromycin,90.91% and 81.82% respectively,and coagulase negative Staphylococci had higher resistance rates to erythromycin and penicillin G,100% and 80% respectively.The CD3+,CD4+ and CD4+/CD8+ in the lung infection group were lower than those in the uninfected group (P＜0.05).Conclusion:The distribution of pathogenic bacteria of pulmonary infection in elderly patients with lung cancer after chemotherapy were mainly Gram-negative bacteria,Gram-negative bacteria were higher rate of cephalosporins,higher rate of Gram-positive bacteria were resistant to penicillin and erythromycin,and decreased immune function in patients with pulmonary infection.