肿瘤致阻塞性肺炎患者呼吸道病原菌及耐药分析  

Distribution and Antibiotic Resistance of Pathogens from Patients with Obstructive Pneumonia Induced by Malignant Tumor

作　　者：王少敏[1] 叶孟[1] 倪曙民[1] 

机构地区：[1]宁波大学医学院附属医院肿瘤内科,浙江宁波315020

出　　处：《中华医院感染学杂志》2010年第22期3608-3610,共3页Chinese Journal of Nosocomiology

基　　金：宁波市社会发展科研项目(2007C10085)

摘　　要：目的分析肿瘤致阻塞性肺炎患者呼吸道感染病原菌的分布及耐药性特点,为肿瘤所致阻塞性肺炎患者的合理用药提供依据。方法通过对2006年7月-2009年12月103例阻塞性肺炎患者进行痰培养,使用VITEK-32全自动细菌仪进行细菌鉴定,K-B纸片扩散法进行药敏试验。结果 309份痰标本中共分离出病原菌464株,其中革兰阴性杆菌268株,革兰阳性球菌114株,真菌82株,排在前几位的病原菌为铜绿假单胞菌、肺炎克雷伯菌、白色假丝酵母菌、凝固酶阴性葡萄球菌及金黄色葡萄球菌,革兰阴性杆菌较敏感的药物为阿米卡星、亚胺培南、哌拉西林/他唑巴坦及多黏菌素B;铜绿假单胞菌对阿米卡星、庆大霉素、多黏菌素B及妥布霉素耐药率<10.00%;肺炎克雷伯菌对多黏菌素B、亚胺培南及美罗培南的耐药率为0,鲍氏不动杆菌对米诺环素及多黏菌素B的耐药率分别为5.65%及18.64%;革兰阳性球菌较敏感的药物为万古霉素、利奈唑胺;肺炎链球菌对万古霉素及利奈唑胺较敏感,耐药率均为0,对左氧氟沙星的耐药率为18.45%;金黄色葡萄球菌对万古霉素、利奈唑胺及呋喃妥因的耐药率分别为2.27%、0、2.30%。结论阻塞性肺炎患者临床感染的病原菌同样主要是革兰阴性杆菌,但病原菌分布上较革兰阳性球菌及真菌偏高,在抗菌药物耐药方面有着自己的特点。OBJECTIVE To investigate the distribution of pathogens and their antibiotic resistance in respiratory tract infection patients with obstructive pneumonia induced by malignant tumor, and provide basis for rational selection of clinical drugs in these patients. METHODS The sputum specimens were cultured from 10a cases of obstructive pneumonia. Pathogens were detected from qualified sputum specimens and identified by VITEK-32 automatic microbial analyzing system. Drug susceptibility was determined by K-B test. RESULTS From 309 sputum speeimens,464 pathogens were detected from Jul 2006 to Dec 2009, including 268 strains of Gram-negative bacilli, 114 strains of Gram positive cocci, and 82 strains of fungi. The main pathogens were Pseudomonas aeruginosa , Klebsiella pneumoniae , Candida albicans , coagulase-negative staphylococcus and Staphylococcus aureus. Drugs selected sensitive to Gram-negative bacilli were amikacin, imipenem, piperacillin/tazobactam and polymyxin B. P. aeruginosa was senstive to amikacin, gentamicin, polymyxin B and tobramycin, drug-resistance rates to these antibiotics were below 10%. The drug-resistance rates of K. pneumoniae to polymyxin B, imipenem and meropenem all were 0% ,the drug-resistance rates of A. baumannii to minoeycline and polymyxin B were 5.65% and 18.64%. vancomycin and linezolid were sensitive to Gram-positive cocci. Str. pneumoniae was sensitive to vancomycin and linezolid,drug-resistance rates to both antibiotics were 0% ,to Levofloxacin is 18.45% ; the drugresistance rates of S. aureus to vancomycin, Linezolid and nitrofurantion were 2. 27%, 0% and 2. 30%. CONCLUSIONS Compared to other lung infection, Gram negative bacilli also are the major pathogens of patients with obstructive pneumonia induced by malignant tumor, but the rate of Gram-negative bacilli and fungi is higher. More patients are infected by more than one pathogen which show special characteristics in drugs resistance.

关 键 词：肿瘤 阻塞性肺炎 呼吸道 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]