肠杆菌科细菌致恶性肿瘤患者肺部感染的临床特点与耐药性分析  

The clinical characteristics and drug resistance of Enterobacteriaceae-associated lung infection in patients with malignant tumor

作　　者：俞丽红 缪汉强[2] 

机构地区：[1]永康市第五人民医院检验科,浙江永康321300 [2]浙江大学医学院附属第二医院检验科,浙江杭州310009

出　　处：《中国微生态学杂志》2015年第5期596-599,603,共5页Chinese Journal of Microecology

摘　　要：目的探讨肠杆菌科细菌致恶性肿瘤患者肺部感染的临床特点、病原学构成和耐药特征,为今后的临床治疗提供参考。方法收集2009年7月至2014年6月本院住院恶性肿瘤患者下呼吸道标本,应用BD Phoenix100全自动微生物鉴定仪鉴定菌种,药敏试验采用纸片法(K-B)进行,并进行ESBLs检测,按CLSI标准判定药敏结果,用WHONET 5.6软件分析数据。结果从恶性肿瘤患者下呼吸道标本中共分离肠杆科细菌256株,主要为肺炎克雷伯菌和大肠埃希菌,分别占39.5%和33.2%;药敏试验表明常见肠杆菌科细菌除对碳青霉烯类、含酶抑制剂抗菌素耐药率较低外,对其余抗菌药物均为中高度耐药;肺炎克雷伯菌的ESBLs检出率最高为60.4%。结论从本院恶性肿瘤合并下呼吸道感染患者中分离出的肠杆菌科细菌多重耐药现象严重,产酶率高,治疗该类细菌感染,首选碳青霉烯类、含酶抑制剂抗菌素,临床应加强ESBLs检测和耐药性监测,防止多重耐药菌的产生。Objective To investigate the clinical characteristics of Enterobacteriaceae-associated lung infection in patients with malignant tumors, the pathogen composition and drug resistance in order to provide reference for future treatment. Methods Lower respiratory tract specimens from malignant tumor patients admitted during July 2009 and June 2014 were collected. BD PhoenixlO0 automated microbiology system was used for the identification of the pathogens. Disk diffusion （K-B） method was used to detect drug susceptibility. ESBLs were detected. CI,SI stand- ard was used to determine drug susceptibility results, and WHONET 5.6 software to analyze the data. Results 256 strains of Enterobacteriaceae were isolated, mainly Klebsiella pneumoniae （39. 5% ） and Escherichia coli （33.2%）. Drug sensitivity test showed that the pathogen was moderately or highly resistant to most of antibiotics except carbapenems and antibacterials containing enzyme inhibitor. The highest detection rate of ESBLs was seen in Klebsiella pneumoniae （60.4%）, Conclusion The Enterobacteriaceae strains isolated from our hospital in patients with malignant tumor with lower respiratory infection exhibited serious multiple drug resistance, and the enzyme production rate is high. Carbapenems and antibacterials containing enzyme inhibitor are the first choices for the treatment. The detection of ESBLs and monitoring of antimicrobial resistance should be strengthened to prevent the prevalence of multiple drug-resistant strains.

关 键 词：肠杆菌科细菌 恶性肿瘤 肺部感染 临床特点 耐药性 

分 类 号：R378.2[医药卫生—病原生物学]