| Silicosis is a systemic pulmonary fibrosis disease,which is mainly due to inhalation of free silica crystals.It continues to get worse even patients don't contract silica crystals any more.According to the course of development,silicosis can be divided into stage ?,?,?.Silicosis in patients with pulmonary morphology and physiological function was degenerative changes,and most of the merger with chronic obstructive pulmonary disease(COPD),combined with systemic immune function.They have high rat of lower respiratory tract infection(LRTI)in the hospital.Poor prognosis,or even death are often followed by infection.Silicosis has a longer hospital stay and more chance of hospital infection during hospitalization.LRTI is the most common complication of silicosis.Long-term course of siliosis can cause the patient resistance decreased.That is why silicosis patients prone to lower respiratory tract infection.The use of antibiotics in clinic,and the variation of pathogen resistance bring difficulties for treatment.To find suitable antibiotics for LRTI silicosis patients is the key point to the treatment.Therefore,it is very important to understand the occurrence and development trend of pathogen resistance of inpatients with lower respiratory tract infection in patients with silicosis.Therefore,understanding the occurrence and development trend of drug resistance of pathogens of LRTI in patients with silicosis,experience of treatment,rational use of anti infective to reduce medical costs,prevention and treatment of bacterial resistance has an important guiding significance.In this study,we retrospectively analyzed the phlegm segment of the patients with silicosis in our hospital to explore the characteristics of LRTI in patients with different stages of silicosis.The pathogen and drug susceptibility were analyzed to provide the basis for clinical treatment.Materials and Method(1)Patients included: Our study contain 1036 sputum sample with silicosis were admitted to hospital under the respiratory tract infection in NO5 people's hospital of Suzhou city from June 2013 to June 2015(867 males,5 females,aged 57-88 years,Stage I 581,Stage II 92,Stage III 199).(2)Grouping: The patients were divided into three groups: stage ?,stage ? and stage ?according to "pneumoconiosis diagnostic criteria and principles of treatment" of China in2009.Pathogenic bacteria and drug sensitivity were analyzed.(3)Identification of sputum culture and Drug sensitivity test: The specimens were received in the blood plate and chocolate plate,were cultured in 5% CO2 incubator.Cultured pathogens were identified and tested for susceptibility by VITEK 2 Compact System Bacteria Semi-automatic Bacteria Identification Drug Sensitive Analyzer.The minimum antimicrobial concentration(MIC)method was used for the drug sensitivity statistics,following the NCCLS standard.The identification of fungi was carried out by the Bio Mérieux identification test strips,France.Fungi drug sensitive paper and agar plates were purchased from the FMerière company,France.The bacterial culture plate purchased from An Tu,Zhengzhou.Drug susceptibility board purchased from Merière company,France.Quality control are the standard strains of Escherichia coli,Staphylococcus aureus standard strains,as well as Pseudomonas aeruginosa standard strains.(4)Statistical analysis: SPSS 13.0 software was used for data analysis.The test level was ?= 0.05 Results:(1)The distribution and composition of pathogens in silicosis patients: A total of 473 strains were isolated and cultured in 1036 specimens.Among them,322 strains(68.08%)were Gram-negative bacteria,mainly Klebsiella pneumoniae(136((38.7%),Pseudomonas aeruginosa(85(17.97%))and Acinetobacter baumannii(38(8.03%)).106 strains were Gram-positive bacteria(21.78%),mainly Staphylococcus aureus 52(10.99%).48(10.15%)cases had fungi infection.(2)The results showed that bacteria is different in different stage of silicosis.Klebsiella pneumoniae is main bacteria in Stage I silicosis patients,while,Pseudomonas aeruginosa and Candida albicans infection are common in Stage III silicosis patients.(3)Gram negative strains in silicosis patients with LRTI rate of Klebsiella pneumoniae,Pseudomonas aeruginosa,Bauman Acinetobacter,Escherichia coli resistant to Amikacin rate were 9.56%,12.94%,31.58% and 26.67%,the resistance to imipenem were 2.94%,27.06%,15.79% and 6.67%.(4)Gram positive strains in silicosis patients with LRTI rate of Staphylococcus aureus and Streptococcus pneumoniae sensitive to teicoplanin and vancomycin were 100%,while for fosfomycin resistance rates were 28.84% and 13.33%.Conclusions:(1)G-bacterias are main cause of LRTI in silicosis patients in hospital.Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii take higher proportion;Staphylococcus aureus,Streptococcus pneumoniae are popular G+ bacterias.(2)Different stage of patients with silicosis combining hospital LRTI have different bacteria characteristics.Klebsiella pneumoniae is common in stage I patients,Klebsiella pneumoniae and Candida albicans are common in stage II patients,Pseudomonas aeruginosa and Candida albicans infection are common in stage III patients.(3)For patients with silicosis complicated with lower respiratory tract infection,imipenem and amikacin have a higher sensitivity to G-bacteria,while vancomycin,teicoplanin and fosfomycin have a positive effect on G+bacteria?... |
PDF Full Text Request