| 石杨磊,杨永,张智辉.肺癌根治术后肺炎病人病原菌分布、耐药性及风险因素研究[J].安徽医药,2025,29(12):2461-2465. |
| 肺癌根治术后肺炎病人病原菌分布、耐药性及风险因素研究 |
| Distribution of pathogenic bacteria, drug resistance and risk factors in patients with pneumonia after radical resection of pulmonary carcinoma |
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| DOI：10.3969/j.issn.1009-6469.2025.12.027 |
| 中文关键词: 肺切除术 手术后并发症 肺炎 病原菌 耐药性 风险因素 |
| 英文关键词: Pneumonectomy Postoperative complications Pneumonia Pathogenic bacteria Drug resistance Risk factor |
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| 中文摘要: |
| 目的探讨肺癌根治术后肺炎病人的病原菌分布特征和耐药性，并分析影响病人死亡的风险因素。方法回顾性分析 2021年 1月至 2024年 2月平顶山市第一人民医院收治的 98例肺癌根治术后继发肺炎病人的临床资料。所有病人进行痰培养、病原菌鉴定、药敏试验，分析病原菌分布特征和耐药性。以查阅病历的方式收集临床资料，包括性别、年龄、机械通气、合并脓毒症休克、慢性阻塞性肺疾病、基础疾病的数目、器官功能损害的数目、呼吸频率、氧合指数、格拉斯哥昏迷评分、血尿素氮。根据病人住院 28 d预后分为死亡组( n=27)和存活组( n=71)分析死亡风险因素。结果分离出 127株病原菌，革兰阴性菌65.35%(83/127)，包括铜绿假单胞菌( 20.47%)、鲍曼不动杆7.32%)等；革兰阳性菌 22.83%(29/127)，包括金黄色葡萄球菌菌(1(12.60%)、肺炎链球菌( 7.87%)等；真菌 11.81%(15/127)。铜绿假单胞菌对头孢类、哌拉西林 /他唑巴坦、阿米卡星、美罗培南、替加环素等的耐药率均低于 30%。鲍曼不动杆菌对哌拉西林 /他唑巴坦、美罗培南、替加环素等的耐药率均低于 30%。金黄色葡萄球菌对万古霉素、替考拉宁、利奈唑胺 0耐药。白色假丝酵母菌对伊曲康唑 0耐药。 logistic回归分析显示，肺癌根治术后肺炎病人死亡的风险因素包括脓毒症休克( OR=2.02)、器官功能损害 ≥3个( OR=3.16)。结论革兰阴性菌是肺癌根治术后肺炎的主要病原菌，耐药性较高且存在多重耐药现象，对于脓毒症休克伴随多器官功能损害高的病人应重点防护，合理选用抗生素治疗，以降低病死率。 |
| 英文摘要: |
| Objective To explore the distribution characteristics and drug resistance of pathogenic bacteria in patients with pneumo-nia after radical resection of pulmonary carcinoma, and to analyze the risk factors for death.Methods A retrospective analysis was per-formed on the clinical data of 98 patients with pneumonia after undergoing radical resection of pulmonary carcinoma, who were admit-ted to Pingdingshan First People's Hospital from January 2021 to February 2024. All patients underwent sputum culture, pathogenidentification, and drug sensitivity testing to analyze the distribution characteristics and drug resistance of pathogenic bacteria. Theclinical data were collected by reviewing medical records, including gender, age, mechanical ventilation, presence of septic shock, pres-ence of chronic obstructive pulmonary disease, number of underlying diseases, number of damaged organs, respiratory rate, oxygenationindex, Glasgow coma score, and blood urea nitrogen. According to 28-day prognosis, the patients were assigned to death group (n=27) or survival group (n=71). The risk factors for death were analyzed. Results Among the 127 strains of pathogenic bacteria isolated,65.35% (83/127) were strains of Gram negative bacteria, including Pseudomonas aeruginosa (20.47%) and Acinetobacter baumannii(17.32%), 22.83% (29/127) strains of Gram-positive bacteria, including Staphylococcus aureus (12.60%) and Streptococcus pneumoni-ae (7.87%), and 11.81% (15/127) strains of fungi. The resistance rates of Pseudomonas aeruginosa to cephalosporins, piperacillin/tazo-bactam, amikacin, meropenem, and tigecycline were lower than 30%. The resistance rates of Acinetobacter baumannii to piperacillin/tazobactam, meropenem, and tigecycline were lower than 30%. Staphylococcus aureus was not resistant to vancomycin, teicoplanin, orlinezolid. Candida albicans was not resistant to itraconazole. Logistic regression analysis results showed that septic shock (OR=2.02) and damaged organs ≥3 (OR=3.16) were risk factors for death.Conclusions Gram-negative bacteria are main pathogenic bacteria ofpneumonia after radical resection of pulmonary carcinoma, with high resistance rates and multi-drug resistance. Patients with septicshock and significant multiple organ dysfunction need monitoring and protecting and rational selection of antibiotics therapy is requiredto reduce mortality. |
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