肿瘤患者脑膜败血伊丽莎白菌肺部感染的临床与耐药性分析
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摘要
目的分析脑膜败血伊丽莎白菌(EM)致肿瘤患者肺部感染的临床特征与耐药性,为临床治疗提供参考。方法回顾性分析2011年1月-2017年12月金华广福医院肿瘤合并EM肺部感染患者的临床资料。结果严重的基础疾病、侵入性诊疗、使用广谱抗菌药物、免疫抑制剂和激素是EM引起肿瘤患者肺部感染的相关危险因素。合并其他感染比例为86.1%,感染病原菌以革兰阴性菌为主。药敏试验表明EM对多种抗菌药物表现为高度耐药和多药耐药,仅对米诺环素、万古霉素、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、红霉素、克林霉素保持较低的耐药性,其耐药率分别为2.8%、8.3%、11.1%、13.9%、16.7%、19.4%。结论严重的基础疾病、多种侵入性操作和长期使用广谱抗菌药物是导致肿瘤患者EM肺部感染的主要危险因素。EM对多种β-内酰胺酶抗菌药物高度耐药,米诺环素和万古霉素是抗感染治疗的首选药物。
Objective To analyze the clinical characteristics and drug resistance with pulmonary infection in tumor patients caused by Elizabethkingia meningospetica,so as to provide reference for clinical treatment. Methods The clinical data of tumor patients with lung infection caused by Elizabethkingia meningospetica( EM) in Guangfu Hospital from January 2011 to December 2017 were analyzed retrospectively. Results Severe underlying diseases,invasive diagnosis and treatment,the use of broad-spectrum antibiotics,immunosuppressive agents and hormones were related risk factors of lung infection caused by EM. The ratio of combining with other infections was 86. 1%,the main pathogens were Gram-negative bacteria. Drug susceptibility tests showed that EM was highly resistant and multidrug resistant to a variety of antimicrobial agents,and was only low resistant to minocycline,vancomycin,piperacillin/tazobactam,cefoperazone/sulbactam,erythromycin and clindamycin,with the drug resistance rates of 2. 8%,8. 3%,11. 1%,13. 9%,16. 7%,19. 4%,respectively. Conclusion Severe basic diseases,multiple invasive operations and long-term use of broad-spectrum antibiotics were the major risk factors for EM lung infection in cancer patients. EM was highly resistant to a variety of beta lactamase antibiotics,and minocycline,vancomycin were the first drugs for anti infection treatment.
Objective To analyze the clinical characteristics and drug resistance with pulmonary infection in tumor patients caused by Elizabethkingia meningospetica,so as to provide reference for clinical treatment. Methods The clinical data of tumor patients with lung infection caused by Elizabethkingia meningospetica( EM) in Guangfu Hospital from January 2011 to December 2017 were analyzed retrospectively. Results Severe underlying diseases,invasive diagnosis and treatment,the use of broad-spectrum antibiotics,immunosuppressive agents and hormones were related risk factors of lung infection caused by EM. The ratio of combining with other infections was 86. 1%,the main pathogens were Gram-negative bacteria. Drug susceptibility tests showed that EM was highly resistant and multidrug resistant to a variety of antimicrobial agents,and was only low resistant to minocycline,vancomycin,piperacillin/tazobactam,cefoperazone/sulbactam,erythromycin and clindamycin,with the drug resistance rates of 2. 8%,8. 3%,11. 1%,13. 9%,16. 7%,19. 4%,respectively. Conclusion Severe basic diseases,multiple invasive operations and long-term use of broad-spectrum antibiotics were the major risk factors for EM lung infection in cancer patients. EM was highly resistant to a variety of beta lactamase antibiotics,and minocycline,vancomycin were the first drugs for anti infection treatment.
引文
[1]王珂,王伟.心外科ICU脑膜败血性黄杆菌致呼吸机相关性肺炎危险因素及耐药性分析[J].中华医院感染学杂志,2013,23(1):36-38.
[2]陶琪,王彩莲.下呼吸道感染脑膜败血伊丽莎白菌的临床分布及耐药性分析[J].中国乡村医药,2016,23(13):41-42.
[3]鲁梅华,洪永富.脑膜炎败血黄杆菌致恶性肿瘤患者下呼吸道感染的临床分析[J].中国微生态学杂志,2014,26(8):935-937.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[5]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:730-731.
[6]CLSI.Performance standards for antimicrobial susceptibility testing:twenty-first informational supplement.CLSI document M100-S21[S].Wayne,PA:Clinical and Laboratory Standards Institute,2011.
[7]陈杏春,农生洲,赵丽,等.脑膜败血伊丽莎白菌感染特征及耐药性分析[J].中华医院感染学杂志,2014,24(20):4961-4992.
[8]李晖,黄金莲,雷考宁.等.肺恶性肿瘤患者下呼吸道感染的病原菌及耐药性分析[J].广西医学,2008,30(8):1210-1211.
[9]黄庆宁,刘丁,陈萍,等.脑膜败血伊丽莎白金菌引发成年患者下呼吸道感染的危险因素及耐药性分析[J].中华医院感染学杂志,2012,22(14):3028-3030.
[10]许斌,吴开进,高英.等.恶性肿瘤患者医院内感染的分析[J].右江民族医学院学报,2008,30(1):49-50.
[11]孙桂芹,李蒙,王蕾,等.脑膜炎败血伊丽莎白金菌感染的临床分布及耐药性分析[J].中国微生态学杂志,2014,26(5):540-543.
[12]杨祖群,王荔,代珍雨,等.儿童医院32株脑膜炎败血性黄杆菌医院感染临床特征及耐药性分析[J].中华医院感染学杂志,2017,27(1):193-195.
[13]林美丽,吴俊琪,黄俊伟,等.我院脑膜败血伊丽莎白菌的临床分布、产酶情况及耐药性分析[J].中国药房,2016,27(14):1926-1929.
[14]汪丽,金海英,王峰,等.72株脑膜败血伊丽莎白菌的临床分布与耐药状况分析[J].中国消毒学杂志,2016,33(8):758-760.
[15]吴朝霞,方寅飞.重症患者继发脑膜败血伊丽莎白菌感染的临床病因与耐药性[J].中国微生态学杂志,2016,28(1):72-75.
[2]陶琪,王彩莲.下呼吸道感染脑膜败血伊丽莎白菌的临床分布及耐药性分析[J].中国乡村医药,2016,23(13):41-42.
[3]鲁梅华,洪永富.脑膜炎败血黄杆菌致恶性肿瘤患者下呼吸道感染的临床分析[J].中国微生态学杂志,2014,26(8):935-937.
[4]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[5]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:730-731.
[6]CLSI.Performance standards for antimicrobial susceptibility testing:twenty-first informational supplement.CLSI document M100-S21[S].Wayne,PA:Clinical and Laboratory Standards Institute,2011.
[7]陈杏春,农生洲,赵丽,等.脑膜败血伊丽莎白菌感染特征及耐药性分析[J].中华医院感染学杂志,2014,24(20):4961-4992.
[8]李晖,黄金莲,雷考宁.等.肺恶性肿瘤患者下呼吸道感染的病原菌及耐药性分析[J].广西医学,2008,30(8):1210-1211.
[9]黄庆宁,刘丁,陈萍,等.脑膜败血伊丽莎白金菌引发成年患者下呼吸道感染的危险因素及耐药性分析[J].中华医院感染学杂志,2012,22(14):3028-3030.
[10]许斌,吴开进,高英.等.恶性肿瘤患者医院内感染的分析[J].右江民族医学院学报,2008,30(1):49-50.
[11]孙桂芹,李蒙,王蕾,等.脑膜炎败血伊丽莎白金菌感染的临床分布及耐药性分析[J].中国微生态学杂志,2014,26(5):540-543.
[12]杨祖群,王荔,代珍雨,等.儿童医院32株脑膜炎败血性黄杆菌医院感染临床特征及耐药性分析[J].中华医院感染学杂志,2017,27(1):193-195.
[13]林美丽,吴俊琪,黄俊伟,等.我院脑膜败血伊丽莎白菌的临床分布、产酶情况及耐药性分析[J].中国药房,2016,27(14):1926-1929.
[14]汪丽,金海英,王峰,等.72株脑膜败血伊丽莎白菌的临床分布与耐药状况分析[J].中国消毒学杂志,2016,33(8):758-760.
[15]吴朝霞,方寅飞.重症患者继发脑膜败血伊丽莎白菌感染的临床病因与耐药性[J].中国微生态学杂志,2016,28(1):72-75.