肺癌合并肺部流感嗜血杆菌感染的临床病因、血清分型及耐药性分析-中国药房

肺癌合并肺部流感嗜血杆菌感染的临床病因、血清分型及耐药性分析

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篇名：	肺癌合并肺部流感嗜血杆菌感染的临床病因、血清分型及耐药性分析
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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。
ABSTRACT：	OBJECTIVE： To investigate the clinical etiology， serum type and drug resistance of lung cancer complicated with pulmonary Haemophilus influenzae （Hi） infection， in order to provide reference for infection prevention and rational drug use. METHODS： Clinical data of 8 025 inpatients with lung cancer complicated with pulmonary infection in our hospital from Jan. 2009 to Jun. 2016 were collected， and the clinical etiology of pulmonary Hi infection was analyzed. The slide agglutination method was used for serotyping， nitrocefin slip method was used to detect β-lactamase， K-B method was used for drug sensitivity test， WHONET 5.6 software 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 hormones and other were closely related to pulmonary Hi infection in lung cancer patients （P＜0.05 or P＜0.01）. Among 8 025 specimens，104 strains of Hi were detected with detection rate of 1.30％. Serum type NTHi accounted for 44.23％. Separable strains were mainly b type （22.12％）， followed by f type （17.31％） and a type （11.54％）. Among 104 strains of Hi， 56 strains of β-lactamase were detected with enzyme-producing rate of 53.85％. Drug resistance of 104 strains of Hi to ampicillin， amoxicillin， compound sulfamethoxazole and chloramphenicol were all higher than 35％； drug resistance of Hi to β-lactamase inhibitors， cephalosporins， carbapenems， azithromycin and other antibiotics were all lower than 20％. Drug resistance of β-lactamase producing stains to ampicillin， amoxicillin， compound sulfamethoxazole and chloramphenicol were all higher than those of non-producing strains， with statistical 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 lung cancer is complicated. The serum type of the isolate is mainly NTHi； enzyme production situation is not optimistic， but Hi keeps a low rate of drug resistance to most antibiotics. β-lactamase inhibitors， cephalosporins， carbapenems and azithromycin are first choice for the treatment of Hi infections.
期刊：	2017年第28卷第17期
作者：	朱珊，方寅飞
AUTHORS：	ZHU Shan，FANG Yinfei
关键字：	流感嗜血杆菌；肺癌；肺部感染；临床病因；血清分型；耐药性
KEYWORDS：	Haemophilus influenzae； Lung cancer； Pulmonary infection； Clinical etiology； Serum type； Drug resistance
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