肺癌患者术后并发肺炎克雷伯菌肺部感染的影响因素及耐药性分析
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摘要
目的探讨肺癌患者术后并发肺炎克雷伯菌肺部感染的影响因素及耐药性。方法选取2015年6月至2017年6月间眉山市第二人民医院收治的91例肺癌患者术后并发肺炎克雷伯菌肺部感染的下呼吸道标本,常规分离与培养肺炎克雷伯菌,采用K-B纸片法行药敏实验,总结肺炎克雷伯菌肺部感染耐药情况。结果 91例阳性标本来源于痰液55例(60.4%)、咽拭子22例(24.2%)、纤支镜11例(12.1%)和肺泡灌洗液3例(3.3%)。肺炎克雷伯菌产超广谱B-内酰胺酶(ESBLs)达68.1%(62例)。肺炎克雷伯菌对头孢替坦、亚胺培南及阿米卡星有较高敏感性,且耐药率低。对头孢替坦(5.5%)耐药率最低,其次为亚胺培南(17.6%),对庆大霉素和左氧氟沙星耐药率均达40.0%以上,对氨苄西林耐药高达100.0%。结论肺癌患者术后并发肺炎克雷伯菌肺部感染与免疫功能降低和手术创伤等因素密切相关,耐药率高,对碳青霉烯类抗菌药物敏感性高。
Objective To explore the influencing factors and drug resistance of pulmonary infection caused by Klebsiella pneumoniae after operation for lung cancer. Methods The specimens of the lower respiratory tract were collected from 91 patients with Klebsiella pneumoniae infected disease after the surgery for lung cancer at Meishan Second People's Hospital from June 2015 to June 2017. The routine separation and culture of Klebsiella pneumoniae were carried out. The K-B paper method was used to carry out the drug sensitive test,and drug resistance in patients infected with Klebsiella pneumoniae was summarized.Results The 91 positive specimens were mainly derived from sputum( 55,60. 4%),throat swab( 22,24. 2%),bronchoscope( 11,12. 1%) and bronchoalveolar lavage fluid( 3,3. 3%) respectively. The extended-spectrum beta-lactamase( ESBLs) for Klebsiella pneumoniae isolated from the lower respiratory tract of the patients after lung cancer was 68. 1%,Klebsiella pneumoniae had high sensitivity to cefotetan,imiperem and amikacin and the drug resistance rate was low. Resistance rate was the lowest for cefotetan( 5. 5%),followed by imiperem( 17. 6%). Resistance rates of Klebsiella pneumoniae was over 40. 0% for gentamicin and levofloxacin. Conclusion The infection of Klebsiella pneumoniae after surgery for lung cancer is closely related to the reduction of immune function and increase of surgical trauma. It has high drug resistance rate is and its sensitivity was high to carbapenems antibiotics.
Objective To explore the influencing factors and drug resistance of pulmonary infection caused by Klebsiella pneumoniae after operation for lung cancer. Methods The specimens of the lower respiratory tract were collected from 91 patients with Klebsiella pneumoniae infected disease after the surgery for lung cancer at Meishan Second People's Hospital from June 2015 to June 2017. The routine separation and culture of Klebsiella pneumoniae were carried out. The K-B paper method was used to carry out the drug sensitive test,and drug resistance in patients infected with Klebsiella pneumoniae was summarized.Results The 91 positive specimens were mainly derived from sputum( 55,60. 4%),throat swab( 22,24. 2%),bronchoscope( 11,12. 1%) and bronchoalveolar lavage fluid( 3,3. 3%) respectively. The extended-spectrum beta-lactamase( ESBLs) for Klebsiella pneumoniae isolated from the lower respiratory tract of the patients after lung cancer was 68. 1%,Klebsiella pneumoniae had high sensitivity to cefotetan,imiperem and amikacin and the drug resistance rate was low. Resistance rate was the lowest for cefotetan( 5. 5%),followed by imiperem( 17. 6%). Resistance rates of Klebsiella pneumoniae was over 40. 0% for gentamicin and levofloxacin. Conclusion The infection of Klebsiella pneumoniae after surgery for lung cancer is closely related to the reduction of immune function and increase of surgical trauma. It has high drug resistance rate is and its sensitivity was high to carbapenems antibiotics.
引文
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[3]于鹏,王亮,史蕾,等.肺癌患者术后肺炎克雷伯菌感染的临床研究[J].中华医院感染学杂志,2016,26:2654-2656.
[4]Zha G,Ruiting LI,Wang W,et al.Drug resistance and clinical distribution of ESBLs~+Escherichia coli and Klebsiella pneumoniae strains from culturing blood samples[J].Chinese J Difficult&Complicated Cases,2017,21:125-126.
[5]诸君,赵丹妹,陈建国,等.肺癌患者化疗后肺部感染病原菌分布与耐药性分析[J].检验医学与临床,2017,14:3170-3172.
[6]王惠姣,徐娇君,陈小平,等.ICU患者感染多药耐药肺炎克雷伯菌的耐药性分析[J].中华医院感染学杂志,2016,26:1235-1237.
[7]靳生艳,黄文辉,王蓉,等.肺癌患者姑息治疗后肺部感染病原菌分布与耐药性分析[J].中华医院感染学杂志,2016,26:3392-3394.
[8]程颖,雷新云.新生儿重症监护室肺炎克雷伯菌属感染患儿临床特征及细菌耐药性分析[J].儿科药学杂志,2016,21:42-46.
[9]Mittal S,Sharma M,Chaudhary U.Study of virulence factors of uropathogenic Escherichia coli and its antibiotic susceptibility pattern[J].Indian J Pathol Microbiol,2014,57:61-64.
[10]何吉琼.血液内科住院老年肿瘤患者感染病原菌分布和耐药性分析研究[J].中国肿瘤临床与康复,2014,21:280-282.