重症急性胰腺炎并发感染的茵谱和耐药性  

Spectrum and susceptibility of bacterial isolates from complicated infections among patients with severe acute pancreatitis

作　　者：何馥倩[1] 黄宗文[1] 郭佳[1] 樊景云[1] 陈燕[1] 李永红[2] 刘义刚[3] 

机构地区：[1]四川大学华西医院中西医结合科,四川省成都市610041 [2]四川大学华西基础与法医学院生物医学工程,四川省成都市610041 [3]四川大学华西医院实验医学科,四川省成都市610041

出　　处：《世界华人消化杂志》2007年第32期3418-3422,共5页World Chinese Journal of Digestology

摘　　要：目的:分析我院重症急性胰腺炎患者感染菌谱及药敏情况以便更加合理的应用抗生素.方法:从我院2004-01/2006-12住院治疗的56例SAP感染患者中分离出172株病原菌.标本包括痰液、血液、尿液、中心静脉导管、胆汁、大便、腹腔穿刺液或引流液及CT或B超下细针穿刺取得的胰周脓液和术中取下的胰腺坏死组织及脓液.菌株鉴定和药敏试验检测采用革兰阴性菌的NC21或革兰阳性菌的PC12测试板.结果:感染部位主要是呼吸系统、胰腺及腹腔、血液.分离数居前4位的病原茵是鲍曼不动杆菌(19.19%)、大肠埃希菌(15.70%)、金黄色葡萄球菌(9.30%)、铜绿假单胞菌(8.72%).革兰阴性菌在病原菌中占优势(61.05%),且对多种抗生素有不同程度耐药,对亚胺培南相对敏感.93.75%金葡菌为耐甲氧西林菌株,仅对万古霉素和复方新诺明敏感度高.结论:重症急性胰腺炎感染以革兰阴性菌为优势菌株,具有高度耐药和多重耐药的特点.AIM： To investigate the spectrum or complicated infections among patients with severe acute pancreatitis in West China Hospital, and analyze the antimicrobial susceptibility of common pathogens, to assist in choosing the right antibiotics both for prophylaxis against infection and for treating established infections. METHODS： One hundred and seventy-two pathogens were isolated from a total of 56 patients with acute pancreatitis in West China Hospital during the period between January 2004 and December 2006 （mean age 52 years; 39 males and 17 females）. Detailed investigations were carried out to identify infections and antibiotic sensitivity in patients with suspected infection. These investigations included cultures of blood, urine, bile, stool, fluid drained from the abdominal cavity, indwelling cannulae and catheter tips. Pancreatic tissue and pus were obtained by needle aspiration guided by CT or ultrasound during operation. Susceptibility of pathogens was assayed with MicroScan Walk- Away 40 Blood Culture Analyzer （Dade, USA）. Extended-spectrum of beta-lactamases （ESBLs） was first detected by MicroScan WalkAway 40, and then confirmed by disk diffusion method tests. RESULTS： The main infected sites were the pancreas and respiratory and abdominal cavities, as well as the blood. Acinetobacter baumannii, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa accounted for 19.19%, 15.70%, 9.30% and 8.72%, respectively. Gram-negative bacilli made up the majority of strains （61,05%）, and had resistance to several antibiotics. 93.75% of S. aureus were methicillin- resistant strains, and sensitive to vancomycin and trimethoprim-sulfamethoxazole. CONCLUSION： Pathogens of complicated infections among patients with severe acute pancreatitis are mostly Gram-negative bacilli with high-level and multi-drug resistance. A microbiological survey is important for guiding clinical therapy.

关 键 词：重症急性胰腺炎 并发感染 耐药 

分 类 号：R576[医药卫生—消化系统] R446.5[医药卫生—内科学]