硅肺合并肺部感染患者的流行病学特征及病原菌耐药性分析

目的 了解近年来硅肺合并肺部感染患者的流行病学特征及痰液病原菌分布和药敏情况，为硅肺防治和合理用药提供参考。方法 对四川大学华西第四医院职业病科诊断的硅肺合并肺部感染患者的病例信息及药敏检测结果进行回顾性分析。结果 分析2017年1月–2020年12月收治的病原学检测阳性的硅肺合并肺部感染患者318例，均为男性，发病年龄中位数为51.00岁，接尘工龄中位数为12.40年，病例主要行业为建筑业、有色金属矿选业和煤矿开采业，主要工种为风钻工、挖煤工和采矿工；壹、贰、叁期阳性检出率分别为27.54%、28.32%、32.97%。共培养出341株病原菌，真菌占54.1%，其中白色念珠菌114株（35.8%）；细菌占53.1%，其中革兰阴性菌168株（52.8%），主要为肺炎克雷伯菌（30.2%）；革兰阳性菌仅1株（0.3%），为溶血葡萄球菌。革兰阴性杆菌对氨苄西林耐药性最高，对青霉素G和氧氟沙星敏感性高。结论 随着硅肺的进展，硅肺合并肺部感染患者肺部感染的发生率增加。微生物分析中真菌检出率高，细菌以革兰阴性细菌为主，总体耐药率不容乐观。

Epidemiological Characteristics and Drug Resistance of Microbial Pathogens of Patients With Silicosis Combined With Pulmonary Infection

  Objective  To investigate the epidemiological characteristics of patients with silicosis combined with pulmonary infection in recent years, to study the distribution and the drug susceptibility of fungal and bacterial pathogens in their sputum samples, and to provide references for the prevention and treatment of silicosis and the appropriate drug use.   Methods  The clinical data and drug sensitivity test results of patients with silicosis combined with pulmonary infection diagnosed at the Department of Occupational Diseases, West China Fourth Hospital, Sichuan University were retrospectively analyzed.   Results  A total of 318 patients with silicosis combined with pulmonary infection who received treatment between January 2017 and December 2020 were enrolled. All the patients had positive microorganism test results. All participants were male. Their median age at the time of onset was 51.00 years and the median time of exposure to silica dust at work was 12.40 years. They worked mostly in construction, non-ferrous metal mining, and coal mining. The main types of work they did were pneumatic drilling, coal digging, and mining. The positive detection rates for the first, second and third phases of silicosis were 27.54%, 28.32%, and 32.97%, respectively. A total of 341 strains of fungal and bacterial pathogens were isolated, of which, 54.1% were fungi, including 114 strains (35.8%) of Candida albicans, and 53.1% were bacteria, including 168 strains (52.8%) of gram-negative bacteria, most of which being Klebsiella pneumoniae (30.2%). There was only 1 strain (0.3%) of gram-positive bacteria, namely Staphylococcus hemolyticus. Gram-negative bacilli were most resistant to ampicillin and highly sensitive to penicillin G and ofloxacin.   Conclusion  Among patients with silicosis combined with pulmonary infection, the incidence of pulmonary infection increases along with the progress of silicosis. Microorganism analysis reveals high detection rates for fungi and the bacteria detected are predominantly gram-negative bacteria. The overall prospect for drug resistance rate was not optimistic.