继发及第三型腹膜炎严重腹腔感染病原菌流行特征分析  

Epidemiological Analysis of the Bacteriology of Severe Intra-Abdominal Infections in Critically Ill Patients with Secondary and Tertiary Peritonitis

作　　者：骆雪萍[1] 施善阳[1] 黄巍[1] 

机构地区：[1]广西桂林医学院附属医院ICU,541001

出　　处：《中国全科医学》2010年第15期1667-1670,共4页Chinese General Practice

摘　　要：目的探讨入住重症监护病房(ICU)继发及第三型腹膜炎严重腹腔感染的病原菌流行特征,为围术期合理使用抗菌药物提供参考。方法回顾性分析ICU2005年6月—2009年6月因继发腹膜炎严重腹腔感染及进展为第三型腹膜炎危重患者腹腔病原菌分布、耐药等临床资料,所有患者入ICU前均行腹部急诊手术。结果 46例危重患者共分离出13种病原菌,初始病原菌分布中结肠瘘以肠球菌为主,其余部位病变以革兰阴性杆菌为主。初始及第1周革兰阴性杆菌分别占63.04%(29/46)和51.02%(25/46),以大肠埃希菌为主;第2周之后革兰阴性杆菌分离率下降,革兰阳性球菌分离率增加到50.00%(23/46),以粪肠球菌和屎肠球菌为主。粪肠球菌、屎肠球菌对万古霉素、替考拉宁高度敏感,对其余16种抗菌药物耐药。结论肠球菌是第三型腹膜炎主要病原菌,第2周后病情未缓解应适时选择覆盖肠球菌的抗菌药物,同时应适当抗真菌治疗。Objective To investigate the bacteriology of severe intra-abdominal infections （SIAI） in critically ill patients with secondary and tertiary peritonitis in the ICU of our hospital,with an attempt to promote the proper use of antibiotics pereoperatively.Methods The clinical data of patients with secondary and tertiary peritonitis who were treated in our ICU due to SIAI between June 2005 and June 2009 were retrospectively analyzed.All patients had undergone an emergency abdominal operation before they were admitted into ICU.Results Totally 13 species of pathogen were cultured from 46 patients with SIAI.Enterococci were the main pathogens of colon fistula and aerobic gram-negative bacteria （AGNB） were the main pathogens of conditions in other locations at the time of operation.AGNB （mainly Escherichia coli） accounted for 63.04% and 51.02% of the cultures of abdominal fluid at the time of operation and one week after operation.The prevalence of AGNB decreased and that of Gram-positive bacteria increased in a four-week period.Gram-positive bacteria accounted for 50.00% in week 4,of which Coprococcus faecalis and Enterococcus faecium were dominative.Meanwhile,the incidence of Candida also increased.The susceptibility rates of Coprococcus faecalis and Enterococcus faecium to vancomycin and teicoplanin were 100%,but were highly resistant to other 16 antibiotics.Conclusion Enterococci are the main pathogen of tertiary peritonitis.The antibiotics profile may include those for enterococci if the disease is not improved after two weeks of treatment.Meanwhile,antifungal drugs should be applied appropriately.

关 键 词：继发及第三型腹膜炎 严重腹腔感染 病原菌 肠球菌 

分 类 号：R37[医药卫生—病原生物学]