摘要
目的:探讨肺癌合并肺部流感嗜血杆菌(Hi)感染的临床病因、血清分型及耐药情况,为预防感染和合理用药提供参考。方法:收集我院2009年1月-2016年6月8 025例肺癌合并肺部感染住院患者的临床资料,分析肺部Hi感染的临床病因。采用玻片凝集法进行Hi血清分型试验,头孢硝噻吩纸片法检测其产β-内酰胺酶情况,纸片扩散法进行药敏试验,并采用WHONET 5.6软件处理药敏试验结果。结果:年龄、临床分期、侵入性操作、手术、放化疗、住院时间、使用广谱抗菌药物或激素等11种因素与肺癌患者发生肺部Hi感染密切相关(P<0.05或P<0.01)。8 025份标本中,共检出Hi 104株,检出率为1.30%。其血清分型以非分型为主,占44.23%;可分型菌株以b型居多(22.12%),其次为f型(17.31%)和a型(11.54%)。104株Hi中,检出产β-内酰胺酶菌株56株,产酶率为53.85%。104株Hi对氨苄西林、阿莫西林、复方磺胺甲噁唑和氯霉素的耐药率均超过35%,对β-内酰胺酶抑制剂、头孢菌素类、碳青霉烯类和阿奇霉素等其他抗菌药物的耐药率均低于20%;产β-内酰胺酶菌株对氨苄西林、阿莫西林、复方磺胺甲噁唑和氯霉素的耐药率显著高于非产酶菌株,差异均有统计学意义(P<0.01);而产酶和非产酶菌株对其他抗菌药物的耐药率比较,差异均无统计学意义(P>0.05)。结论:肺癌患者发生肺部Hi感染的临床病因十分复杂。我院检出的Hi以非分型为主,且产酶情况不容乐观,但对多数抗菌药物耐药率较低。临床治疗可首选β-内酰胺酶抑制剂、头孢菌素类、碳青霉烯类和阿奇霉素等抗菌药物。
OBJECTIVE:To investigate the clinical etiology,serum type and drug resistance of lung cancer complicated withpulmonary Haemophilus influenzae(Hi)infection,in order to provide reference for infection prevention and rational drug use.METHODS:Clinical data of8025inpatients with lung cancer complicated with pulmonary infection in our hospital from Jan.2009to Jun.2016were collected,and the clinical etiology of pulmonary Hi infection was analyzed.The slide agglutination method wasused for serotyping,nitrocefin slip method was used to detectβ-lactamase,K-B method was used for drug sensitivity test,WHONET5.6software was used to deal with the results of drug sensitivity test.RESULTS:Eleven factors as age,clinical classification,invasive operation,surgery,radiotherapy and chemotherapy,hospitalization time,use of broad-spectrum antibiotics or hormonesand other were closely related to pulmonary Hi infection in lung cancer patients(P<0.05or P<0.01).Among8025specimens,104strains of Hi were detected with detection rate of1.30%.Serum type NTHi accounted for44.23%.Separable strainswere mainly b type(22.12%),followed by f type(17.31%)and a type(11.54%).Among104strains of Hi,56strains ofβ-lactamasewere detected with enzyme-producing rate of53.85%.Drug resistance of104strains of Hi to ampicillin,amoxicillin,compoundsulfamethoxazole and chloramphenicol were all higher than35%;drug resistance of Hi toβ-lactamase inhibitors,cephalosporins,carbapenems,azithromycin and other antibiotics were all lower than20%.Drug resistance ofβ-lactamase producing stains toampicillin,amoxicillin,compound sulfamethoxazole and chloramphenicol were all higher than those of non-producing strains,withstatistical significance(P<0.01).There was no statistical significance in drug resistance to other antibiotics between producing stains and non-producing strains(P>0.05).CONCLUSIONS:The clinical etiology of pulmonary Hi infection in patients with lungcancer is complicated.The serum type of the isolate is mainly NTHi;enzyme production situation is not optimis
作者
朱珊
方寅飞
ZHU Shan;FANG Yinfei(Laboratory Department,Jinhua Municipal Central Hospital,Zhejiang Jinhua 321000,China)
出处
《中国药房》
CAS
北大核心
2017年第17期2346-2350,共5页
China Pharmacy
关键词
流感嗜血杆菌
肺癌
肺部感染
临床病因
血清分型
耐药性
Haemophilus influenzae
Lung cancer
Pulmonary infection
Clinical etiology
Serum type
Drug resistance
