切换至 "中华医学电子期刊资源库"
高级检索
中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2023, Vol. 16 ›› Issue (06) : 779 -783. doi: 10.3877/cma.j.issn.1674-6902.2023.06.007

论著

肺恶性肿瘤继发下呼吸道感染病原学特点及耐药分析
邢媛媛, 蒋军红, 谢海琴, 吕学东†()   
  1. 226000　南通，南通大学第二附属医院呼吸与危重症医学科
    215000　苏州，苏州大学附属第一医院呼吸与危重症医学科；215000　苏州，苏州大学附属独墅湖医院呼吸与危重症医学科
  • 收稿日期:2023-09-19 出版日期:2023-12-25
  • 通信作者: 吕学东
  • 基金资助:
    江苏省卫生健康委项目(2021WJ2012); 苏州市科技计划发展项关键技术公关(SKY2021026); 南通市卫健委项目(QA2021012)

Analysis of the microbiological characteristics, drug resistance in patients with lower respiratory tract infection secondary to lung malignancies

Yuanyuan Xing, Junhong Jiang, Haiqin Xie, Xuedong Lv†()   

  1. Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Nantong University, Nantong 226000, China
    Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Suzhou University, Suzhou 215000, China; Department of Respiratory and Critical Care Medicine, Dushu Lake Hospital Affiliated to Suzhou University, Suzhou 215000, China
  • Received:2023-09-19 Published:2023-12-25
  • Corresponding author: Xuedong Lv
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

邢媛媛, 蒋军红, 谢海琴, 吕学东. 肺恶性肿瘤继发下呼吸道感染病原学特点及耐药分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(06): 779-783.

Yuanyuan Xing, Junhong Jiang, Haiqin Xie, Xuedong Lv. Analysis of the microbiological characteristics, drug resistance in patients with lower respiratory tract infection secondary to lung malignancies[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(06): 779-783.

目的

分析肺恶性肿瘤继发下呼吸道感染的病原学特点、耐药性和感染相关危险因素。

方法

选择2018年7月至2021年12月南通大学第二附属医院和苏州大学第一附属医院住院行肺泡灌洗外送宏基因组二代测序(metagenomic next-generation sequencing, mNGS)患者158例。肺恶性肿瘤42例分为观察组，非肺恶性肿瘤116例分为对照组。收集肺泡灌洗液，进行病原菌鉴定及药敏试验。采用单因素和多因素分析感染相关危险因素。应用对数秩检验比较两组存活率。

结果

观察组发生下呼吸道感染31例(73.81%)；对照组发生下呼吸道感染101例(87.07%)。观察组多种微生物G－和真菌感染11例。观察组常见流感嗜血杆菌、白色念珠菌、屎肠球菌和铜绿假单胞菌。观察组发生下呼吸道感染耐药菌9例(29.03%)；耐药病原体铜绿假单胞菌常见。Logistic回归分析显示，胸腔积液和肿瘤分期是肺恶性肿瘤继发下呼吸道感染危险因素(P<0.05)。随访期间观察组死亡21例(50.00%)。感染者生存率降低(P<0.05)。

结论

肺恶性肿瘤常见病原体为G－，胸腔积液和肿瘤分期是肺恶性肿瘤发生下呼吸道感染的危险因素，导致肺恶性肿瘤总体生存率降低。

关键词: 肺恶性肿瘤, 下呼吸道感染, 病原学, 耐药, 宏基因组学二代测序技术
Objective

To analyze the microbiological characteristics, drug resistance, and infection-related risk factors of lower respiratory tract infection in patients with lung malignancies.

Methods

All of 158 patients who were hospitalized in the Second Affiliated Hospital of Nantong University and the First Affiliated Hospital of Soochow University from July 2018 to December 2021 were retrospectively analyzed. Metagenomic next-generation sequencing of patients was tested in the alveolar lavage. 42 cases of lung malignant tumor were divided into observation group, 116 cases of non-lung malignant tumor were divided into control group. The patients′bronchoalveolar lavage fluid was collected, and the pathogen identification and drug sensitivity test were carried out. Univariate and multivariate analyses were used to evaluate related risk factors of infections factors. Survival of lung malignancies patients with infected and non-infected was compared using the log-rank test.

Results

In the observation group, 31 patients(73.81%) developed lower respiratory tract infection; in the control group, 101 patients(87.07%) developed lower respiratory tract infection. In the observation group, the infection patterns of various microorganisms were dominated by a mixture of Gram-negative bacteria and fungi in 11 cases. In the observation group, the most common pathogens were Haemophilus influenzae, Candida albicans, Enterococcus faecium, and Pseudomonas aeruginosa. Among the 31 patients with lower respiratory tract infection in the observation group, drug-resistant bacteria were detected in 9 patients(29.03%); the most common drug-resistant pathogen was Pseudomonas aeruginosa. Binary logistic regression analysis showed that pleural effusion and tumor stage were independent risk factors for lower respiratory tract infection in patients with lung cancer (P<0.05). A total of 21 patients (50.00%) died during the follow-up period. Patients in the infection(+ ) group had significantly lower overall survival compared with those in the infection(-) group (P<0.001).

Conclusions

Gram-negative bacteria are the majority of pathogens documented in patients with lung malignancies. Pleural effusion and tumor stage are independent risk factors for lower respiratory tract infection in patients with lung cancer, and infection reduces overall survival in patients with lung cancer.

Key words: Lung malignancies, Lower respiratory tract infection, Etiology, Drug resistance, Metagenomic next-generation sequencing
图1 两组患者多种病原体感染结果
表1 两组下呼吸道感染病原体结果
病原菌 观察组 对照组
株数 构成比(%) 株数 构成比(%)
G＋ 22   36  
具核梭杆菌 3 3.70 1 0.65
肺炎链球菌 5 6.17 7 4.58
屎肠球菌 5 6.17 8 5.22
金黄色葡萄球菌 3 3.70 12 7.84
粪肠球菌 2 2.47 2 1.31
烟曲霉 4 4.94 6 3.92
G－ 47   93  
副百日咳鲍特菌 2 2.47 0 0.00
产黑色普氏菌 3 3.70 8 5.23
铜绿假单胞菌 5 6.17 13 8.50
嗜肺军团菌 2 2.47 0 0.00
流感嗜血杆菌 10 12.34 15 9.80
副流感嗜血杆菌 7 8.64 14 9.15
肺炎克雷伯菌 4 4.94 8 5.23
大肠埃希菌 2 2.47 0 0.00
鲍曼不动杆菌 2 2.47 13 8.50
小韦荣球菌 2 2.47 11 7.18
坦纳拟普雷沃菌 1 1.23 4 2.61
嗜麦芽窄食单胞菌 4 4.94 7 4.58
牙齿放线菌 3 3.70 0 0.00
真菌 12   24  
近平滑念珠菌 3 3.70 6 3.92
白色念珠菌 9 11.11 18 11.76
表2 肺恶性肿瘤下呼吸道感染Logistic回归分析
变　量 B S.E. Wald Sig. Exp(B)
性别 －24.458 1.133E4 0.000 0.998 0.000
年龄 0.088 0.076 1.331 0.249 1.092
慢性阻塞性肺病 0.588 1.684 0.122 0.727 1.800
心血管疾病 1.566 1.460 1.150 0.284 4.785
糖尿病 21.832 1.250E4 0.000 0.999 3.032E9
胸腔积液 －2.018 1.805 3.251 0.033 6.133
免疫治疗 －2.161 1.719 1.581 0.209 0.115
手术治疗 1.201 1.728 0.483 0.487 3.323
抗肿瘤治疗 －1.865 1.745 1.142 0.285 0.155
肿瘤分期 2.461 1.019 5.837 0.016 11.717
常数 11.546 1.133E4 0.000 0.999 1.034E5
图2 下呼吸道感染对肺恶性肿瘤患者生存影响。注：A：肺恶性肿瘤中未感染(－)者和被感染(＋)者总体生存率差异；B：肺恶性肿瘤下呼吸道感染中耐药组和非耐药组总体生存率差异
1
Singh AP, Berman AT, Marmarelis ME, et al. Management of lung cancer during the COVID-19 pandemic[J]. JCO Oncol Pract, 2020, 16(9): 579-586.
2
张睿娟，雷　弋. 早期肺腺癌临床病理特征及分子特征研究进展[J]. 现代肿瘤医学，2021, 29(23): 4246-4250.
3
吴天秀，徐　瑜，廖秀清，等. 驱动基因阴性Ⅲ/Ⅳ期非小细胞肺癌BRCA1/2基因突变与含铂化疗疗效的关系[J/CD]. 中华肺部疾病杂志(电子版), 2023, 16(5): 615-623.
4
Ding R, Zhu D, He P, et al. Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China[J]. BMC cancer, 2020, 20(1): 250.
5
Jiao J, Li Z, Wu X, et al. Risk factors for 3-month mortality in bedridden patients with hospital-acquired pneumonia: A multicentre prospective study[J]. PloS one, 2021, 16(3): e0249198.
6
Zhai T, Li S, Hu W, et al. Potential micronutrients and phytochemicals against the pathogenesis of chronic obstructive pulmonary disease and lung cancer[J]. Nutrients, 2018, 10(7): 813.
7
王晓玲，方　凯，王冬梅，等. 肺癌患者肺霉菌感染和肺细菌感染的CT鉴别诊断[J]. 中华医院感染学杂志，2021, 31(13): 1997-2000.
8
Niles DT, Lee RA, Lamb GS, et al. Plasma cell-free metagenomic next generation sequencing in the clinical setting for the diagnosis of infectious diseases: a systematic review and meta-analysis[J]. Diagn Microbiol Infect Dis, 2023, 105(1): 115838.
9
He S, Wei J, Feng J, et al. The application of metagenomic next-generation sequencing in pathogen diagnosis: a bibliometric analysis based on Web of Science[J]. Front Cell Infect Microbiol, 2023, 13: 1112229.
10
Diao Z, Lai H, Han D, et al. Validation of a metagenomic next-generation sequencing assay for lower respiratory pathogen detection[J]. Microbiol Spectr, 2023, 11(1): e0381222.
11
Parize P, Muth E, Richaud C, et al. Untargeted next-generation sequencing-based first-line diagnosis of infection in immunocompromised adults: a multicentre, blinded, prospective study[J]. Clin Microbiol Infect, 2017, 23(8): 574. e1-574. e6.
12
Pan T, Tan R, Qu H, et al. Next-generation sequencing of the BALF in the diagnosis of community-acquired pneumonia in immunocompromised patients[J]. J Infect, 2019, 79(1): 61-74.
13
Azoulay E, Russell L, Van de Louw A, et al. Diagnosis of severe respiratory infections in immunocompromised patients[J]. Intensive Care Med, 2020, 46(2): 298-314.
14
Shimoda M, Yamana K, Yano R, et al. Analysis of risk factors for the development of a post-bronchoscopy respiratory infection in lung cancer patients[J]. J Infect Chemother, 2021, 27(2): 237-242.
15
Nanayakkara AK, Boucher HW, Fowler JrVG, et al. Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward[J]. CA Cancer J Clin, 2021, 71(6): 488-504.
16
Bou Antoun N, Chioni AM. Dysregulated signalling pathways driving anticancer drug resistance[J]. Int J Mol Sci, 2023, 24(15): 12222.
17
Shoji F, Takeoka H, Kozuma Y, et al. Pretreatment prognostic nutritional index as a novel biomarker in non-small cell lung cancer patients treated with immune checkpoint inhibitors[J]. Lung Cancer, 2019, 136: 45-51.
18
Lin X, Chen X, Long X, et al. New biomarkers exploration and nomogram construction of prognostic and immune-related adverse events of advanced non-small cell lung cancer patients receiving immune checkpoint inhibitors[J]. Respir Res, 2023, 24(1): 64.
19
Mahiat C, Bihin B, Duplaquet F, et al. Systemic Inflammation/Nutritional status scores are prognostic but not predictive in metastatic non-Small-Cell lung cancer treated with first-line immune checkpoint inhibitors[J]. Int J Mol Sci, 2023, 24(4): 3618.
20
陆沈栋，盛泽波. 肺癌并恶性胸腔积液患者血清和胸腔积液肿瘤标志物水平变化及其对良恶性胸腔积液的鉴别诊断价值研究[J]. 实用心脑肺血管病杂志，2018, 26(9): 38-42.
21
李青松，欧阳伟炜，苏胜发，等. 放疗相关因素对伴恶性胸腔积液非小细胞肺癌生存的影响[J]. 中华放射肿瘤学杂志，2021, 30(2): 120-126.
22
田　蜜，雷海科，高翠娥，等. 2292例非小细胞肺癌患者随访及生存预后影响因素研究[J]. 重庆医学，2023, 52(12): 1812-1817.
23
Ding Z, Wang X, Jiang S, et al. Risk factors for postoperative pulmonary infection in patients with non-small cell lung cancer: analysis based on regression models and construction of a nomogram prediction model[J]. Am J Transl Res, 2023, 15(5): 3375.
24
Choi Y, Noh JM, Shin SH, et al. The Incidence and Risk Factors of Chronic Pulmonary Infection after Radiotherapy in Patients with Lung Cancer[J]. Cancer Res Treat, 2023, 55(3): 804-813.
25
Agusti A, Faner R. Lung function trajectories in health and disease[J]. Lancet Respir Med, 2019, 7(4): 358-364.
26
Macdougall A, Jarvis D, Keogh R H, et al. Trajectories of early growth and subsequent lung function in cystic fibrosis: An observational study using UK and Canadian registry data[J]. J Cyst Fibros, 2023, 22(3): 388-394.
27
Tattersall MC, Lee KE, Tsuchiya N, et al. Skeletal Muscle Adiposity and Lung Function Trajectory in the Severe Asthma Research Program[J]. Am J Respir Crit Care Med, 2023, 207(4): 475-484.
28
Rosenfeld M, Faino AV, Qu P, et al. Association of Pseudomonas aeruginosa infection stage with lung function trajectory in children with cystic fibrosis[J]. J Cyst Fibros, 2023, 22(5): 857-863.
29
Muppa P, Terra SBSP, Sharma A, et al. Immune cell infiltration may be a key determinant of long-term survival in small cell lung cancer[J]. J Thorac Oncol, 2019, 14(7): 1286-1295.
30
蒋爱民，马宇彦，刘　娜，等. 肺癌患者院内感染微生物学特点及预后因素分析[J]. 现代肿瘤医学，2022, 30(9): 1598-1602.
[1] 王雪菲, 海琳悦, 李立方, 肖春花. Luminal A型乳腺癌的内分泌治疗与化疗[J]. 中华乳腺病杂志(电子版), 2023, 17(05): 294-300.
[2] 涂家金, 廖武强, 刘金晶, 涂志鹏, 毛远桂. 严重烧伤患者鲍曼不动杆菌血流感染的危险因素及预后分析[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 491-497.
[3] 李维, 莫俊俏. 儿童呼吸道耐药流感嗜血杆菌基因型鉴定及耐药分析对抗菌药物治疗选择的意义[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(05): 315-323.
[4] 张小曼, 马筱秋, 许正锯, 张纯瑜, 何彩婷. 乙型肝炎病毒逆转录酶区耐药突变对血清乙型肝炎病毒表面抗原水平的影响[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(05): 324-332.
[5] 张海金, 王增国, 蔡慧君, 赵炳彤. 2020至2022年西安市儿童医院新生儿细菌感染分布及耐药监测分析[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(04): 222-229.
[6] 武元星, 任建伟, 朱光发. 181例心脏外科患者发生血流感染危险因素分析[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(04): 230-237.
[7] 曹长青, 郭新艳, 高源, 张存, 唐海利, 樊东, 杨小军, 张松, 赵华栋. 肿瘤微环境参与介导HER2阳性乳腺癌曲妥珠单抗耐药的研究进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 90-95.
[8] 刘付有欢, 吴秀芹, 邓翠婷, 苏青. 基于模型的西妥昔单抗治疗胃癌细胞系的反应和耐药因素分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 385-388.
[9] 王晓丹, 王媛, 崔向宇, 任晓磊. 上尿路结石内镜手术后尿源性脓毒血症病原菌耐药及死亡高危因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 611-615.
[10] 何昊, 郑克春, 唐利华, 漆星, 黄成, 牟攀. BDNF、PGRN在COPD伴下呼吸道感染中的表达及预后分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(05): 712-714.
[11] 王庆, 张红联, 吴志勇. COPD合并多重耐药菌肺部感染预后危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 557-559.
[12] 王甜甜, 温媛, 李振, 叶美红, 郭影, 马双. 和厚朴酚调控Nrf2/ARE通路对胃癌细胞的顺铂化疗敏感性的影响[J]. 中华细胞与干细胞杂志(电子版), 2023, 13(04): 202-209.
[13] 李静静, 翟蕾, 赵海平, 郑波. 多囊肾合并囊肿的多重耐药菌感染一例并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(08): 920-923.
[14] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
[15] 林舒楠, 党文强, 钟天, 梁斯欣, 张磊, 唐晓华, 袁文常. 2017—2021年广东地区基层医疗机构金黄色葡萄球菌临床分离株耐药谱分析[J]. 中华临床实验室管理电子杂志, 2023, 11(03): 139-144.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号