食管癌根治术后肺部感染的病原菌与耐药性分析

目的:探讨食管癌根治术后肺部感染的病原菌及耐药性,为临床合理应用抗菌药物提供依据。方法:选择2009年1月-2017年12月在我院行食管癌根治术的764例患者作为研究对象,记录患者临床基本资料,采集肺部感染患者深部痰液标本进行细菌培养,并对病原菌进行药物敏感性试验,分析其病原菌分布和耐药性。结果:764例食管癌根治术后患者肺部感染146例,感染率为19.11%;肺部感染患者痰液标本培养获得病原菌185株,其中革兰阴性菌116株,占62.70%,以铜绿假单胞菌和肺炎链球菌最多,分别占18.38%和14.05%;革兰阳性菌40株,占21.62%,以金黄色葡萄球菌最多,占8.65%;真菌29株,占15.68%,以白假丝酵母菌最多,占9.19%。铜绿假单胞菌、肺炎链球菌、鲍氏不动杆菌、大肠埃希菌对美洛西林的耐药率最高,分别占70.59%、73.08%、86.96%、62.50%,对亚胺培南耐药率最低,分别占5.88%、3.85%、26.09%、12.50%。金黄色葡萄球菌、表皮葡萄球菌对头孢唑林的耐药率最高,分别占81.25%、63.64%,溶血葡萄球菌对头孢唑林、阿奇霉素、环丙沙星的耐药率最高,均占71.43%,肠球菌对头孢唑林、环丙沙星耐药率最高,均占100.00%;黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、肠球菌对万古霉素耐药率最低,均为0.00%。结论:食管癌根治术后肺部感染以革兰阴性菌为主,病原菌主要对美洛西林、头孢唑林、阿奇霉素、环丙沙星产生耐药性,对亚胺培南、万古霉素耐药性较低,临床应合理选用抗菌药物进行治疗。

Analysis on Pathogenic Bacteria and Drug Resistance of Pulmonary Infection after Radical Surgery for Esophageal Carcinoma

ABSTRACT Objective: To explore the pathogenic bacteria and drug resistance of pulmonary infection after radical surgery for esophageal carcinoma, and to provide the basis for clinical rational use of antibacterial drugs. Methods: A total of 764 patients, who underwent radical surgery for esophageal carcinoma in Second Affiliated Hospital of Anhui Medical University from January 2009-December 2017, were chosen as research subjects. The basic clinical data of the patients were recorded.The deep sputum specimens from patients with pulmonary infection were collected for bacterial culture. Drug sensitivity test was performed for pathogenic bacteria, and the distribution and drug resistance of the pathogenic bacteria were analyzed. Results: There were 146 cases of pulmonary infection in 764 cases of radical surgery for esophageal carcinoma, and the infection rate was 19.11%. Among 185 strains of pathogenic bacteria from sputum specimens of patients with pulmonary infection, there were 116 strains of Gram-negative bacteria(62.70%), in which,pseudomonas aeruginosa and Streptococcus pneumoniae were the most, accounting for 18.38% and 14.05% respectively; there were 40 strains of Gram-positive bacteria(21.62%), in which, staphylococcus aureus were the most,accounting for 8.65%, 29 strains of fungi accounting for 15.68%, and Candida albicans were also the most, accounting for 9.19%. The resistance rates of Pseudomonas aeruginosa, Streptococcus pneumoniae, Acinetobacter baumannii, Escherichia coli to mezlocillin were the highest, accounted for 70.59%,73.08%,86.96%, 62.50% respectively, but the resistance rates of them to imipenem were the lowest, accounted for 5.88%, 3.85%, 26.09%, 12.50% respectively. The resistance rates of Staphylococcus aureus, Staphylococcus epidermidis to cefazolin were the highest, accounting for 81.25%, 63.64% respectively. The resistance rates of Staphylococcus haemolyticus to cefazolin, azithromycin, ciprofloxacin were the highest, all accounted for 71.43%. The resistance rates of Enterococci to cefazolin, ciprofloxacin were the highest, all accounted for 100.00%. The resistance rates of Staphylococcus, Staphylococcus epidermidis, Staphylococcus haemolyticus and Enterococcus to vancomycin were the lowest, all accounted for 0.00%. Conclusion: The pulmonary infection is Gram-negative bacteria mainly after radical surgery for esophageal carcinoma. The pathogenic bacteria is resistant to mezlocillin, cefazolin, azithromycin,ciprofloxacin mainly, the resistance rates of pathogenic bacteria to imipenem and vancomycin are lower.Antibiotics should be used rationally for clinical treatment.