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目的明确基层医院老年肺癌患者并发肺部医院感染的病原菌分布及其耐药性特点,以期指导临床合理用药。方法对2014年1月-2015年12月老年肺癌疑有肺部感染患者的下呼吸道分泌物、支气管肺泡灌洗液,进行病原体培养、鉴定及药敏试验。结果 386例老年肺癌患者的标本中培养出病原菌428株,其中革兰阴性杆菌292株,占68.2%,主要为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌;革兰阳性球菌78株,占18.2%,主要为金黄色葡萄球菌、表皮葡萄球菌、肠球菌属;真菌58株,占13.6%,主要为白色念珠菌。药敏结果显示,革兰阴性杆菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢吡肟的耐药率较低(<29.5%),对青霉素类、喹诺酮类、氨曲南耐药率较高(36.4%~78.8%);革兰阳性球菌对万古霉素、替考拉宁100%敏感,对青霉素类、喹诺酮类、大环内酯类等耐药率较高(38.3%~85.7%)。结论老年肺癌患者易并发院内肺部感染,主要病原菌为革兰阴性杆菌,且存在较严重的耐药现象,应加强病原学监测,以提高治疗成功率。
Objective To clarify the distribution of pathogenic bacteria in elderly patients with lung cancer and pulmonary infection in primary hospitals and their drug resistance characteristics so as to guide clinical rational drug use. Methods From January 2014 to December 2015, the lower respiratory secretions and bronchoalveolar lavage fluid of elderly patients with suspected pulmonary infection of lung cancer were cultured, identified, and susceptibility tested. Results A total of 428 pathogenic bacteria were cultured in 386 elderly patients with lung cancer, of which 292 were Gram-negative bacilli (68.2%), mainly Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, 78 strains of gram-positive cocci, accounting for 18.2%, mainly Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus; 58 strains of fungi, accounting for 13.6%, mainly Candida albicans. The results of drug sensitivity showed that the resistance rate of Gram-negative bacilli to imipenem, meropenem, piperacillin / tazobactam, cefoperazone / sulbactam and cefepime was low (<29.5%), The resistance rate to penicillins, quinolones and aztreonam was high (36.4% -78.8%). Gram-positive cocci were 100% sensitive to vancomycin and teicoplanin, and resistant to penicillins, quinolones, macrocycles Ester and other drug resistance rate is higher (38.3% ~ 85.7%). Conclusions Elderly patients with lung cancer are prone to have pulmonary infections in the hospital. The main pathogens are Gram-negative bacilli and there are more serious drug resistance. Etiological monitoring should be strengthened to improve the success rate of treatment.