Lesion Bacterial Investigation Of Patients Suffer From Cutaneous Squamous Cell Carcinoma

Objective: To investigate the distribution and durg resistance of the isolated bacteria from the patients with cutaneous squamous cell carcinoma(CSCC),the purpose is to direct clinician rational using antimicrobial agents in order to control and decrease the development of bacterial resistance.Methods: Between January 2007 and September 2010,167 patients with CSCC from out-patients and new in-patients were enrolled,taking the qualified surface or deep specimens from these lesions to culture,according to standards of CLSI.The isolated bacteria were identified by VITEK TWO automated microbiology system.The patients were divided into different groups according to age,sex,position,infectious symptoms,duration and diameter to survey the relation with the positive rate of germiculture. Antimicrobial susceptibility testing was carried out by means of Kirby-bauer.The date was analysed with SPSSl3.0 software.Results: 1,139 cases were positive in the bacterial culture with a positive rate was 83.2%.They were all 149 strains of baeterial for 25 species.There were 84 strains of Gram-negative bacilli(56.4%),63 strains of Gram-positive bacilli(42.3%) and 2 strains of fungi(1.3%).The five kind of pathogens of the highest detection rate were:Staphylococcus aureus(23.5%),E.coli (16.8%),Staphylococcus epidermidis (12.1%),Klebsiella pneumoniae(10.1%),Pseudomonas aeruginosa(8.7%).2,167 cases were divided into gerontism group(≥60y)and non-gerontism group( < 60y).The positive germiculture rate was 89.1% and 76.0%(P<0.05).The difference was significant.The positive rate of the 95 male patients and 72 female patients were 84.2% and 81.9%(P>0.05).The difference was insignificant.The positive rate of the 108 patients with head or face CSCC and 59 patients with other parts CSCC were 81.5% and 86.4%(P>0.05).The difference was insignificant.But the five kind of pathogens of the highest detection rate in head and face group were Staphylococcus aureus,Staphylococcus epidermidis,E.coli,Klebsiella pneumoniae,Pseudomonas aeruginosa.They were E.coli,Staphylococcus aureus,Staphylococcus epidermidis, Klebsiella pneumoniae,Pseudomonas aeruginosa in the other parts group.The pathogens distribution is different.The positive rate of the 89 patients with infectious symptoms and 78 patients with no infectious symptoms were 85.4% and 80.8%(P>0.05). The difference was insignificant.The five kind of pathogens of the highest detection rate in infectious symptoms group were Staphylococcus aureus,E.coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Staphylococcus epidermidis.But they were Staphylococcus epidermidis,Staphylococcus aureus,E.coli,Klebsiella pneumoniae,Pseudomonas aeruginosa in no infectious symptoms group.The pathogens distribution is different.The positive rate of the 117 patients for longer duration(≥1 year) and 50 patients for shorter duration(<1year) were 87.2% and 74.0%(P<0.05).The difference was significant.The positive rate of the 65 patients with larger diameter(≥2cm) and 102 patients with smaller diameter(<2cm) were 90.8% and 70.4%(P<0.05).The difference was significant.The Gram-negative bacilli were highly resistant to ampicillin,ticarcillin,cefazolin,cefalotin,cefuroxime,cefotaxime and cefepime.Cefoperazone/sulbactum and piperazone/tazobactam were more active antibiotic against the Gram-negative bacilli.Meropenem and imipenem were the most active antibiotic against them.The Gram-positive bacilli were highly resistant to penicillin,erythromycin and clindamycin.Teicoplanin were more active antibiotic against them.Vancomycin and linezolid weren't found resistant.Conclusion: 1. Conditional pathogenic bacteria are the most common pathgens of the CSCC patients. Proportion of Gram-negative bacilli are slightly higher than Gram-positive bacilli. 2. Age,course of disease and diameter of lesion had important influence to percentage of positive cultures.Gender,part and infectious symptoms had no significant relationship with percentage of positive cultures in CSCC lesion.The group of head or face SCC and the group of the other part CSCC were different in bacteria distribution.The group of infectious symptoms and the group of no infectious symptoms were different in bacteria distribution. 3. The Gram-negative bacilli were highly resistant to ampicillin.β-lactam andβ-lactamase inhibitor combination were more active antibiotic against them. Carbapenem was the most active antibiotic against them.The Gram-positive bacilli were highly resistant to penicillin.Teicoplanin, vancomycin and linezolid were the most active antibiotic against them. 4. So understanding the situation of bacterial resistance, reasonable application of antimicrobial agents and to strengthen the management of antimicrobial agents and monitoring has significant importance to better guide clinicians to choose antimicrobial agents,reduce postoperative incision infection of CSCC patients and controlle the development of bacteria resistance.