肺癌患者下呼吸道病原菌分布特征与耐药性分析  

Distribution and drug resistance of pathogens isolated from lower respiratory tract in patients with lung cancer

作　　者：孟红委 娄加陶[1] MENG Hongwei;LOU Jiatao(Department of Clinical Laboratory,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]上海市胸科医院/上海交通大学附属胸科医院检验科,上海200030

出　　处：《国际检验医学杂志》2021年第17期2123-2127,2131,共6页International Journal of Laboratory Medicine

摘　　要：目的了解肺癌患者下呼吸道病原菌分布及耐药性,以指导临床经验治疗及合理使用抗菌药物。方法将2015-2019年于该院治疗且行痰培养检查的共4753例肺癌患者纳入研究,对从患者痰标本分离的病原菌进行鉴定和体外药敏试验,分析病原菌的分布特点和耐药情况。结果共672例患者的痰培养标本检出病原菌(共720株),检出率为14.1%(672/4753)。其中革兰阴性菌、革兰阳性菌、真菌分别占71.5%、6.9%、21.5%。在所有病原菌中所占比例排名前5的依次为肺炎克雷伯菌(21.0%)、铜绿假单胞菌(16.8%)、白色念珠菌(16.5%)、鲍曼不动杆菌(11.0%)、金黄色葡萄球菌(5.0%)。肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌对氨苄西林/舒巴坦、左旋氧氟沙星、环丙沙星、头孢他啶、妥布霉素、庆大霉素均较为敏感。白色念珠菌对常用的抗真菌药物均敏感,如两性霉素B、氟康唑、伊曲康唑、伏立康唑、5-氟胞嘧啶。未发现对替加环素、万古霉素、利奈唑胺、奎奴普丁/达福普汀耐药的金黄色葡萄球菌。结论肺癌患者下呼吸道病原菌种类复杂,以革兰阴性菌为主。临床对于下呼吸道感染的肺癌患者可以根据耐药监测结果进行经验治疗,并根据具体的药物敏感性试验结果进行针对性治疗。Objective To investigate the distribution and drug resistance of pathogens isolated from lower respiratory tract in patients with lung cancer,and to improve clinical treatment of bacterial infections.Methods Patients with lung cancer who were treated in the hospital from 2015 to 2019 and underwent sputum culture examinations were enrolled in the study.Pathogenic bacteria isolated from patients′sputum samples were identified and underwent drug susceptibility tests.The distribution characteristics and drug resistance of pathogens were analyzed.Results A total of 720 strains of pathogens were isolated from 672 patients with lung cancer,and the positive rate was 14.1%(672/4753).Among them,Gram-negative bacteria,Gram-positive bacteria and fungi accounted for 71.5%,6.9%and 21.5%,respectively.The top 5 pathogens were Klebsiella pneumoniae(21.0%),Pseudomonas aeruginosa(16.8%),Candida albicans(16.5%),Acinetobacter baumannii(11.0%)and Staphylococcus aureus(5.0%).Drug susceptibility test showed that ampicillin/sulbactam,levofloxacin,ciprofloxacin,ceftazidime,tobramycin,gentamicin were the most effective drugs against Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii.Candida albicans were sensitive to common antifungal drugs,such as amphotericin B,fluconazole,itraconazole,voriconazole,5-flucytosine.Staphylococcus aureus were sensitive to tigecycline,vancomycin,linezolid,quinupristin/dalfopristin.Conclusion The types of pathogens isolated from patients with lung cancer were complex,mainly Gram-negative bacteria.Lung cancer patients with lower respiratory tract infection can be empirically treated based on the results of drug resistance monitoring,and given targeted treatment based on the results of specific drug susceptibility tests.

关 键 词：肺癌 下呼吸道 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学]