恶性肿瘤患者医院获得性肺炎病原菌特点及耐药性研究

目的 :探讨恶性肿瘤患者医院获得性肺炎的发病机理、病原菌菌型分布及耐药现状。方法 :对 2 0 0 2～2 0 0 3年我院 5 6例恶性肿瘤患者医院获得性肺炎患者痰液中分离的 5 8株致病菌进行菌型分类 ,并选用 15种常用抗菌药物对其进行了体外MIC药敏试验。结果 :恶性肿瘤患者医院获得性肺炎病原菌分离前 5位分别是 :铜绿假单胞菌 2 9 3%、鲍曼氏不动杆菌 2 0 7%、肺炎克雷伯氏菌 19%、金黄色葡萄球菌 8 6 %、嗜麦芽假单胞菌 6 9% ,药敏结果表明 ,所有革兰氏阴性菌对抗菌药物耐药率均呈上升趋势 ,尚未发现耐万古霉素的MR SA菌株。结论 :住院时间长、长时间使用抗菌素、肿瘤消耗以及免疫抑制是恶性肿瘤患者医院获得性肺炎的易感因素 ,铜绿假单胞菌、鲍曼氏不动杆菌、肺炎克雷伯氏菌、金黄色葡萄球菌、嗜麦芽假单胞菌是恶性肿瘤患者医院获得性肺炎的主要致病菌 ,在临床治疗中 ,必须重视早期预防、及时诊断、合理使用抗菌素 ,才能预防或减少医院获得性肺炎的发生以及控制院感菌日益增高的耐药趋势

Study of the Pathogens and Resistance Pattern of Nosocomial Pneumonia in the Patients with Malignant Tumor

Objective:To investigate the pathogenesis, distribution of the pathogens and resistance pattern of nosocomial pneumonia in the patients with malignant tumor. Methods: Bacterial type was conducted on the 58 stains separated from the sputum of the patients of nosocomial pneumonia in the 56 cases with malignant tumor in our hospital from 2002 to 2003. And the most common 15 antibiotics were conducted on the MIC drug sensitive test in vitro . Results: The most common pathogens of nosocomial pneumonia in the patients with malignant tumor were: Pseudomonas aeruginosa29.3%, Acinetobacter baumannii 20.7%, Klebsiella pneumoniae 19%,Staphylococcus aureus 8.6%,Xanthomonas maltophilia 6.9%,according to the drug sensitive tests, antimicrobial-resistant gram-negative bacilli were increasing. None of the vancomycin-resistant MRSA variant was seen. Conclusions: The risk factors of nosocomial pneumonia in the patients with malignant tumor are long hospital stay, unreasonable antibiotic therapy, tumor consumption and immune inhibition. The most common pathogens are Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Xanthomonas maltophilia . Effective infection-control procedures, surveillance systems and appropriate antimicrobial selection are key partners in limiting nocosomial pneumonia and antimicrobial-resistant pathogen occurrence.