摘要
目的检测食管癌患者根治术后合并肺部感染病原菌的分布和耐药性情况,并对肺部感染发生的危险因素进行分析,为肺部感染的预防和合理用药提供参考。方法选取2015年1月至2018年12月在四川省肿瘤医院胸外科行食管癌根治术后并发肺部感染的405例患者,采集痰液标本作病原菌检查并进行耐药性试验;统计患者的年龄、性别、是否合并高血压等信息,进行肺部感染单因素分析。结果405例食管癌根治术后合并肺部感染患者痰液标本共培养出病原菌463株,其中革兰阴性(G)菌298株,占64.36%;革兰阳性(G+)菌106株,占22.89%;真菌59株,占12.74%。G菌中检出率较高的是铜绿假单胞菌、肺炎克雷伯菌鲍曼不动杆菌,3种菌对哌拉西林、头孢唑啉.左氧氟沙星、庆大霉素、氨曲等11种抗菌药物的耐药率较高,为16.67%~95.65%;对哌拉西林他唑巴坦、头孢哌爾舒巴坦、亚胺培南的耐药率较低,为2.90%~9.64%.G+菌中检出率较高的是金黄色葡萄球菌和表皮葡萄球菌,其对青霉素、阿莫西林,阿奇霉素等6种抗菌药物的耐药率为32.26%~100%,对利福平.利奈唑胺.万古霉素的耐药率0~12.90%。真菌中检出率较高的是白假丝醇母菌和热带假丝酵母菌,其对酮康唑的耐药率为20.00%~25.71%,对伊曲康唑和两性霉素B的耐药率为0~5.71%。单因素分析表明,年龄、病理分期、手术时间、住院时间是食管癌患者根治术后发生肺部感染的危险因素(P<0.05)。结论食管癌患者根治术后肺部感染发生率较高,其感染致病菌菌谱广泛且具有一定的耐药性,而且肺部感染的发生与高龄、病理晚期、手术时间和住院时间长等因素有关。及时进行感染病原菌种类和耐药性监测以及危险因素分析对于预防和控制食管癌患者肺部感染的发生及抗菌药物的合理应用具有重要意义。
Objective To determine the distribution and drug resistance of pathogens in patients with a pulmonary in-fection after radical resection of esophageal cancer and to analyze the risk factors for a pulmonary infection in order to a provide reference for the prevention of pulmonary infections and rational use of drugs.Methods Subjects were 405 pa-tients who developed a pulmonary infection after radical resection of esophageal cancer in Thoracic Surgery at Sichuan Cancer Hospital from January 2015 to December 2018.Sputum samples were collected to test for pathogens,and a drug resistance test was conducted.Information such as age,sex,and whether one had hypertension was collected and ana-lyzed using univariate analysis.Results Four hundred and sixty three strains of pathogens were cultured from sputum samples from 405 patients with a pulmonary infection after esophagectomy.Of those strains,298(64.36%)were strains of Gram-negative bacteria,106(22.89%)were strains of Gram-positive bacteria,and 59(12.74%)were strains of fun-gi.The Gran-negative bacteria detected most often were Pseudomonas aeruginosa,Klebsiella pneumoniae,and Acineto-bacter baumannii.Those three bacteria were more resistant(16.67-95.65%)to 11 antimicrobial agents such as pip-eracillin,cefazolin,levofloxacin,gentamicin,and aztreonam and less resistant(2.90-9.64%)to piperacillin tazobac-tam,cefoperazone/sulbactam,and imipenem.The Gram-positive bacteria detected most often were Sta phylococcus aureus and s.epidermidis.Those two bacteria were more resistant(32.26-100%)to 6 antimicrobials such as penicllin,amoicllin,and azithromycin and less resistant(0-12.90%)to rifampicin,linezolid,and vancomycin.The fungi detec-ted most often were Candida albicans and C.tropicalis.These species were resistant to ketoconazole at a rate of 20.00-25.71%and resistant to itraconazole and amphotericin B ata rate of 0-5.71%.Univariate analysis indicated that,age,pathological stage,operating time,and duration of hospitalization were risk factors for development of a pulmonary infec-tion in patients who underwent radical resection of esophageal cancer(P<0.05).Conclusion Patients who underwent radical resection of esophageal cancer developed a pulmonary infection at a high rate,and the development of a pulmonary inection was related to factors such as being elderly,a late pathological stage,a long operating time,and a long duration of hospitalization.Promptly determining the types of pathogens causing infections,monitoring their drug resistance,and analysis of risk factors and the rational use of antimicrobials are crucial to the prevention and control of a pulmonary infec-tion in patients with esophageal cancer.
作者
张智光
郑琇山
韩泳涛
ZHANG Zhi-guang;ZHENG Xiu-shan;HAN Yong-tao(Thoracic Surgery,Pidu District People's Hospital,Chengdu,China 611730;Thoracic Surgery,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu,China 610041)
出处
《中国病原生物学杂志》
CSCD
北大核心
2019年第12期1460-1463,共4页
Journal of Pathogen Biology
关键词
食管癌根治术
肺部感染
病原菌分布
耐药性试验
危险因素
Radical resection of esophageal cancer
pulmonary infection
pathogen distribution
drug resistance test
risk factors
