| Objective: By collecting the clinical data of patients with lung abscess in our hospital,the pathogen distribution and drug resistance of lung abscess were researched,so as to we can obtain information for reasonably empirical choice of antibiotics in clinic.Method: Clinical data of 238 patients with lung abscess admitted to our hospital on January 1,2015 and July 1,2020 were collected.The results of sputum culture and drug sensitivity test were statistically analyzed to analyze the pathogen distribution and drug resistance of lung abscess.Results:238 cases of patients,159 cases of primary,57 cases of secondary and 22 cases of blood-derived lung abscess.There were 187 males and 51 females,The average ages were respectively(59.26±13.06)years and(58.90±15.80)years.98 cases(41.18%)were positive in sputum culture.There were 155 strains in total,including 82 strains(52.9%)of G-bacilli,3 strains(1.94%)of G+ cocci and 70 strains(45.16%)of fungi.The main pathogenic bacteria of G-bacillus were Klebsiella pneumoniae 25 strains,accounting for 16.13%(25/155),Pseudomonas aeruginosa 22 strains,accounting for 14.19%(22/155),Acinetobacter baumannii 15 strains,accounting for9.67%(15/155),Escherichia coli 5 strains,accounting for 3.22%(5/155),and other G-bacillus 15 strains,accounting for 9.67%(15/155).Nine strains(36%,9/25)of extended-spectrum β-lactamases(ESBLs)and three strains(12%,3/25)of multidrug resistant(MDR)strains were detected in 25 strains of KP.2 strains of ESBLs,accounting for 40%(2/5),and 1 strain of MDR,accounting for 20%(1/5),were detected in the 5 strains of EC.There were 3 strains of G+ coccus,including 2 strains of streptococcus angina and 1 strain of Staphylococcus aureus,accounting for 1.29%(2/155)and 0.65%(1/155),respectively.Among the 70 strains,47 strains(30.32%)were mainly Candida albicans.No anaerobe culture was performed in 238 patients.Forty-nine strains of G-bacilli were detected in primary lung abscess,among which 17 strains(17.71%,17/96)were mainly Klebsiella pneumoniae.Twenty-seven strains of G-bacilli were detected in secondary lung abscess,of which 12 strains were mainly Pseudomonas aeruginosa,accounting for 27.28%(12/44).Six strains of G-bacilli were detected in blood-borne lung abscess,among which 4 strains were mainly Klebsiella pneumoniae,accounting for 26.66%(4/15).Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii were the top three G-bacilli detected in lung abscess complicated with diabetes mellitus and stroke,and Pseudomonas aeruginosa,Klebsiella pneumoniae and Acinetobacter baumannii were the top three G-bacilli detected in lung abscess complicated with diabetes mellitus and stroke.The drug resistance rate of Klebsiella pneumoniae and Escherichia coli to tigacycline and minocycline was 0%,Pseudomonas aeruginosa drug resistance rate to polymyxin was 0%.The drug resistance rates of Klebsiella pneumoniae、Escherichia coli 、 Pseudomonas aeruginosa to amikacin,meropenem,imipenem,piperacillin/tazobactam,and cefoperazone/sulbactam were less than 30%.Acinetobacter baumannii had no drug resistance to tigacycline and polymyxin,and the drug resistance rate to cotrimoxazole and minocycline was less than 30%.Drug resistance rates of Candida albicans to fluconazole、voriconazole were 0.The drug resistance rate of Klebsiella pneumoniae in patients with stroke and other lung diseases was higher than that in patients with diabetes mellitus,but it was more sensitive to amikacin,ertapenem,meropenem,imipenem,cefoperazone/sulbactam,piperacillin/tazobac tam etc and the drug resistance rate was less than 25%.Pseudomonas aeruginosa of patients with diabetes mellitus,stroke and other pulmonary diseases had low resistance to many antibiotics,while Acinetobacter baumannii had high resistance to most antibiotics,but had high sensitivity to cotrimoxazole and ticacycline.NEUT%,C-reactive protein,procalcitonin and D-dimer were significantly higher in blood-derived lung abscess than secondary and primary lung abscess,with statistically meaning(P<0.05).The positive rate of pathogens in the basic disease group was higher than that in the non-basic disease group,with statistical difference(P < 0.05).In basic diseases,the positive rate of pathogens in diabetes and other pulmonary diseases group was higher than that in the group without diabetes and other pulmonary diseases,but the difference was not statistically significant(P > 0.05).The positive rate of pathogen in stroke group was higher than that in non-stroke group,and the difference was statistically significant(P < 0.05).The detection rate of Pseudomonas aeruginosa in patients with other lung diseases was higher than that in patients without other lung diseases,and the difference was statistically significant(P < 0.05).Conclusion:1.G-bacillus was the most common pathogen in lung abscess,followed by fungi.G-bacillus common pathogens included Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli.The most common pathogen of fungi is Candida albicans.G+ cocci were less.The distribution of pathogens in lung abscess is related to the way of infection and the basic diseases.2.Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli can be selected G-bacilli sensitive antimicrobial agents such as aminoglycosides,β-lactam +enzyme inhibitor complex,carbapenems antimicrobial agents.Acinetobacter baumannii can choose to its sensitive antimicrobial drugs such as tigacycline,polymyxin,polymyxin,cotrimoxazole,minocycline.If fungi are present,we should select antifungal agents which were sensitive to Candida albicans,such as fluconazole and voriconazole.3.NEUT%,CRP,PCT and D-Dimer can be used as inflammatory monitoring indexes of blood-derived lung abscess.The risk of bacterial infection in patients with basic diseases and stroke is increased,and the treatment of basic diseases in patients with lung abscess is required to be strengthened.The risk of infection with Pseudomonas aeruginosa in patients with lung abscess and other lung diseases is increased,and the treatment should use antibacterial drugs that can cover the bacteria. |
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