摘要
目的分析非霍奇金淋巴瘤（NHL）化疗后肺部感染的病原学及耐药性,以期提高NHL化疗后肺部感染的预防及诊治水平。方法选取医院2012年3月-2013年3月42例NHL化疗后肺部感染患者,行痰培养及药敏试验,并给予针对性治疗。结果共培养出病原菌55株,其中双重感染8例,多重感染2例,其中革兰阴性菌38株占69.09%;革兰阳性菌9株占16.36%;真菌8株占14.55%,前5位病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、白色假丝酵母菌、金黄色葡萄球菌、鲍氏不动杆菌,分别占21.82%、16.36%、14.55%、10.91%、10.91%;铜绿假单胞菌、肺炎克雷伯菌对广谱抗菌药物高度耐药,鲍氏不动杆菌对头孢菌素100.00%耐药,对头孢哌酮/舒巴坦、美罗培南耐药率均〉50.00%;患者经抗感染及对症支持治疗后,37例患者感染于2~3周后得到有效控制,5例患者由于多药耐药菌感染,营养状况差合并多种基础疾病,于治疗2～4周死亡,病死率11.90%。结论非霍奇金淋巴瘤化疗后肺部感染病原菌以革兰阴性菌为主,针对病原菌耐药率高的特点,治疗时在合理使用抗菌药物基础上积极改善机体免疫力,加强支持治疗,可缓解粒细胞缺乏,提高治疗效果。
OBJECTIVE To analyze the etiology and drug resistance of chemotherapy lung infections after nonHodgkin′s lymphoma（NHL）,so as to improve the diagnosis and treatment level for lung infection after nonHodgkin′s lymphoma.METHODS A total of 42cases of NHL with lung infections were selected in our hospital from Mar.2012to Mar.2013,sputum pathogen culture and sensitivity test were taken.All patients were given targeted treatment.RESULTS A total of 55strains of pathogens were cultured,among which there were co-infection in 8cases,multiple infection in 2cases.There were 38strains of G-cocci,accounting for 69.09% and G＋ bacteria 9strains,16.36% and fungi 8strains 14.55%.The top five pathogens were Pseudomonas aeruginosa, accounting for 21.82%,Klebsiella pneumoniae,accounting for 16.36%,Candida albicans,accounting for 14.55%,Staphylococcus aureus,accounting for 10.91%,Acinetobacter accounting for 10.91%.Pseudomonas aeruginosa and Klebsiella pneumoniae were highly resistant to antimicrobial agents,A.baumannii were 100%resistant to cephalosporins and to cefoperazone/sulbactam and meropenem were more than 50.00% resistant.Patients with anti-infection and symptomatic and supportive treatment,the infections in 37cases of patients had been effectively controlled in 2-3weeks,and 5patients with multi-drug-resistant infections,poor nutritional status and merged a variety of underlying diseases,died at 2-4weeks of treatment,and the mortality rate was 11.90%. CONCLUSION After chemotherapy of non-Hodgkin′s lymphoma,the lung infection pathogens were mainly G-cocci.For the characteristics of the high resistance of pathogenic bacteria,treatment based on the rational usage of antimicrobial agents should be able to actively improve immunity,and strengthen support for treatment to alleviate agranulocytosis and improve the therapeutic effect.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第9期2119-2121,共3页
Chinese Journal of Nosocomiology
基金
南阳市卫生局专项基金项目(HN-2010B-052)
关键词
非霍奇金淋巴瘤
化疗
肺部感染
诊治
病原学分析
Non-Hodgkin′s lymphoma
Chemotherapy
Lung infection
Treatment
Etiological analysis
