老年肺癌伴COPD急性加重期46例病原学分析  

Etiological Analysis on 46 Elderly Lung Cancer Patients Complicated with Acute Exacerbation of COPD

作　　者：张慧娟[1] 张波[2] 闫春良[1] 薛旗山[1] 赵秋红[1] 聂晓丽[1] 

机构地区：[1]北京航天总医院呼吸内科,北京100076 [2]北京航天总医院消化内科,北京100076

出　　处：《肿瘤药学》2017年第1期99-103,共5页Anti-Tumor Pharmacy

摘　　要：目的对老年肺癌伴COPD急性加重期46例患者行病原学检测分析。方法选取2009年1月至2016年2月我院呼吸病房的46例肺癌伴COPD老年患者为研究对象。采集标本进行真菌、细菌培养及药敏试验,分析病原菌种类及耐药情况。结果 46例患者中共检出病原菌29株。其中革兰阴性杆菌17株(58.6%),包括铜绿假单胞菌8株(47.1%)、肺炎克雷伯菌5株(29.4%),大肠埃希菌3株(17.6%)、鲍曼不动杆菌1株(5.9%);共检出革兰阳性球菌8株(27.6%),包括金黄色葡萄球菌4株(50.0%)、溶血葡萄球菌3株(37.5%)、肺炎链球菌1株(12.5%);检出真菌4株(13.8%),包括白色念珠菌3株(75.0%)、热带念珠菌1株(25.0%)。对每株细菌进行药敏试验,显示革兰阴性菌耐药性在复方新诺明及氨苄西林上较高,而在头孢第一、二代耐药性上高于第三代;其中以铜绿假单胞菌耐药率最高。革兰阳性菌耐药性在万古霉素中敏感率达到100%,而在氨基糖苷类、头孢类及喹诺酮类敏感率较低。真菌药敏试验结果显示2株对氟康唑敏感,1株对脒康唑敏感,1株对伊曲康唑敏感。结论老年肺癌伴COPD急性加重以革兰阴性菌为主要致病原,且混合感染多见,由于长期放化疗治疗过程造成细菌耐药严重,因此应根据药敏结果合理使用抗生素。Objective To make the etiology analysis for 46 elderly lung cancer patients complicated with acute exacerbation of chronic obstructive pulmonary disease （COPD）. Methods Forty-six lung cancer patients complicated with COPD were selected in our respiration department between January 2009 and February 2016. Through the culture of fungus and bacterium and drug sensitive test, the types and drug resistance of pathogenic bacteria were analyzed. Results There were 29 strains of pathogenic bacteria. There were 17 strains of gram- negative bacillus （58.6%）, including eight strains of Pseudomonas aeruginosa （47.1%）, five strains of Klebsiella pneumoniae （29.4%）, three strains of Escherichia coli （17.6%） and one strain ofAcinetobacter baumanii （5.9%）. There were eight strains of gram-positive bacillus （27.6%）, including four strains of Staphylococcus aureus （50.0%）, three strains of Staphylococcus haemolyticus （37.5%） and one strain of Streptococcus pneumoniae （12.5%）. And there were four strains of fungus （13.8%）, including three strains of Candida albicans （75.0%） and one strain of Candia tropicalis （25.0%）. Through the drug test, it was observed that the gram-negative bacillus had a higher drug resistance on paediat- ric compound sulfamethoxazole tablets and amicillin. Moreover, its drug resistance on the first and second generation of cephalosporin was higher than on the third generation of cephalosporin. The drug resistance ofpseudomonas aeruginosa was the highest. The drug resistance of gram-negative bacillus on Vancomycin was 100%, while its resistance on aminoglycosides, quinolones, and cephalosporin was lower. Through the drug sensitive test on fungus, there were two sensitive cases on fluconazole, one on miconazole and the other one on itraconazole. Conclusion For elderly lung cancer patients complicated with acute exacerbation of COPD, the major pathogenic bacteria is G-bacterium of which the mixed infection is commonly seen. During the long-term chemoradiothera

关 键 词：肺癌 COPD 感染 病原体 耐药 

分 类 号：R734.2[医药卫生—肿瘤]