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目的探讨恶性肿瘤患者不发酵糖革兰阴性杆菌的临床分布特点及耐药情况。方法对2013年7月—2015年6月本院恶性肿瘤患者临床送检标本检出的1 630株不发酵糖革兰阴性杆菌构成、来源及药物敏感试验结果进行统计分析。结果 1 630株不发酵糖革兰阴性杆菌中居前4位的菌种分别为铜绿假单胞菌809株(49.63%),鲍曼不动杆菌240株(14.72%),嗜麦芽寡养单胞菌171株(10.49%),醋酸钙不动杆菌124株(7.61%);痰液检出852株(52.27%)、血液检出206株(12.64%)、咽拭子检出130株(7.98%);消化系统肿瘤(食管癌、胃癌和肠癌)、血液系统肿瘤、肺癌、头颈部和耳鼻喉癌患者检出率分别为38.95%、19.57%、9.51%和9.51%;不发酵糖革兰阴性杆菌对13种抗菌药物的耐药率为2.72%~85.38%,其中铜绿假单胞菌对亚胺培南(22.25%)、头孢他啶(21.63%)和哌拉西林(20.89%)耐药性较高,对阿米卡星(7.42%)及多黏菌素B(2.72%)耐药性较低;鲍曼不动杆菌对哌拉西林(63.25%)耐药性最高,其次为哌拉西林-他唑巴坦(59.17%),对阿米卡星(16.67%)耐药性最低;嗜麦芽窄食单胞菌对哌拉西林(85.38%)耐药性最高,其次为哌拉西林-他唑巴坦(80.70%),对头孢哌酮/舒巴坦(14.62%)和左氧氟沙星(15.20%)耐药性较低;醋酸钙不动杆菌对环丙沙星及亚胺培南(25.81%)耐药性最高,对阿米卡星(12.90%)耐药性最低。结论本院2013年7月—2015年6月恶性肿瘤患者检出不发酵糖革兰阴性杆菌种类较多,以铜绿假单胞菌最为多见,痰液检出率最高,菌种耐药性差异较大,临床应根据药物敏感试验结果选用有效的抗菌药物。
Objective To investigate the clinical characteristics and drug resistance of non-fermentative Gram-negative bacilli in patients with malignant tumors. Methods A total of 1 630 untreated Saccharomyces Gram-negative bacilli isolated from clinical specimens of patients with malignant tumors in our hospital from July 2013 to June 2015 were analyzed statistically. Results The top 4 strains of 1 630 non-fermentative Saccharomyces Gram-negative bacilli were 809 (49.63%) of Pseudomonas aeruginosa, 240 (14.72%) of Acinetobacter baumannii, 117 strains (10.49%), 124 strains (7.61%) of Acinetobacter calcoaceticus, 852 (52.27%) sputum samples, 206 (12.64%) samples blood samples and 130 %). The detection rates of digestive system tumors (esophageal cancer, gastric cancer and bowel cancer), hematologic tumors, lung cancer, head and neck and ear, nose and throat cancer patients were 38.95%, 19.57%, 9.51% and 9.51% The resistance rates of Gram-negative bacilli to 13 kinds of antibacterials ranged from 2.72% to 85.38%, among which resistance to P. aeruginosa was imipenem (22.25%), ceftazidime (21.63%) and piperacillin (20.89%) The antibacterial activity of amikacin (7.42%) and polymyxin B (2.72%) was relatively low. Acinetobacter baumanii had the highest drug resistance to piperacillin (63.25%), followed by Piperacillin-tazobactam (59.17%) had the lowest resistance to amikacin (16.67%). Stenotrophomonas maltophilia was the most resistant to piperacillin (85.38%), followed by piperazine Laceillin-tazobactam (80.70%), cefoperazone / sulbactam (14.62%), and left oxytocin Sand Star (15.20%) resistance is low; calcium acetate Acinetobacter (25.81%) the highest resistance to ciprofloxacin and imipenem, (12.90%) the lowest resistance to amikacin. Conclusions Our hospital from July 2013 to June 2015 detected more non-fermentable Saccharomyces Gram-negative bacilli, the most common were Pseudomonas aeruginosa, the highest sputum detection rate and the antibiotic resistance The difference is large, clinical should be based on the results of drug susceptibility testing of effective antimicrobial drugs.