食管癌术后化疗患者肺部感染的病原菌分析及耐药性分析

目的分析食管癌术后化疗患者肺部感染病原菌的特点,并探讨病原菌耐药性,指导临床选择合理抗菌药物治疗食管癌化疗后肺部感染。方法选择182例食管癌术后化疗合并肺部感染的患者,分析病原菌分布情况及耐药性。结果182例患者共分离出病原菌236株,其中革兰阴性菌151株,革兰阳性菌56株,真菌29株。革兰阳性菌中金黄色葡萄球菌占比最高,其次为表皮葡萄球菌、肺炎链球菌;革兰阴性菌中铜绿假单胞菌占比最高,其次为鲍曼不动杆菌、肺炎克雷伯菌;真菌中以白色假丝酵母菌为主。革兰阳性菌及革兰阴性菌中主要病原菌均对多种常用抗菌药物存在不同程度耐药,金黄色葡萄球菌对头孢唑林、庆大霉素、红霉素及青霉素有较严重耐药(耐药率≥70.00%),对克林霉素及万古霉素有较低耐药(耐药率<30.00%);表皮葡萄球菌对头孢唑林、头孢曲松、庆大霉素、红霉素及青霉素有较严重耐药,对万古霉素不耐药;铜绿假单胞菌对头孢唑林及复方新诺明有较严重耐药,对亚胺培南、美罗培南、头孢呲肟、哌拉西林及阿米卡星有较低耐药;鲍曼不动杆菌对头孢唑林及氨曲南有较严重耐药,对亚胺培南及美罗培南有较低耐药。结论食管癌术后化疗合并肺部感染患者的病原菌主要为革兰阴性菌、革兰阳性菌、对多种抗菌药物存在不同程度的耐药性,应针对患者病原菌类型选择具有较低耐药性的抗菌药物,以避免抗菌药物滥用,提高肺部感染治疗效果。

Analysis of Pathogenic Bacteria and Drug Resistance of Lung Infection in PatientsUndergoing Chemotherapy after Esophageal Cancer Surgery

Objective To analyze the characteristics of pathogenic bacteria of lung infection in patients undergoing chemotherapy after esophageal cancer surgery,and to explore the drug resistance of pathogens,to guide the selection of clinical rational antibacterial drugs for the treatment of lung infections after chemotherapy of esophageal cancer.Methods 182 patients with postoperative esophageal cancer chemotherapy and lung infections were selected.The distribution and drug resistance of pathogenic bacteria were analyzed.Results 236 pathogenic bacteria were isolated from 182 patients,including 151 of gram-negative bacteria,56 of gram-positive bacteria,and 29 of fungi.Of staphylococcus aureus,gram-positive bacteria hadthe highest proportion,and the next were Staphylococcus epidermidis and Streptococcus pneumoniae;of pseudomonas aeruginosa,gram-negative bacteria had the highest proportion,followed by Acinetobacter baumannii and Klebsiella pneumoniae;In fungi,mainly was Candida albicans.Among both Gram-positive and Gram-negative bacteria,the main pathogens were resistant to a variety of commonly used antimicrobial drugs to various degrees.Staphylococcus aureus was highly resistant to cefazolin,gentamicin,erythromycin and penicillin(resistance rate≥70.00%),the resistance to clindamycin and vancomycin was mild(resistance rate<30.00%);staphylococcus epidermidis was highly resistant to cefazolin,ceftriaxone,gentamicin,erythromycin and penicillin,but not resistant to vancomycin;pseudomonas aeruginosa was highly resistant to cefazolin and compound trimethoprim,but was lowly resistant to imipenem,meropenem,cephalosporin,piperacillin and amikacin;Acinetobacter baumannii was highly resistant to cefazolin and aztreonam,but was lowly resistant to imipenem and meropenem.Conclusion The pathogenic bacteria in patients with postoperative chemotherapy for esophageal cancer and lung infection are mainly gram-negative bacteria and gram-positive bacteria,which have various degrees of resistance to various antibacterial drugs.Antibacterial drugs with lower drug resistance should be selected according to the type of pathogenic bacteria in patients,in order to avoid abuse of antibacterial drugs and improve the treatment effect of lung infection.