肛周脓肿病原学特征的调查分析  

Study on characteristics of pathogenic bacteria causing perianal abscess

作　　者：宋新江[1] 张利萍[1] 严水根[1] 钱小毛[2] 金海勇[2] 

机构地区：[1]绍兴第二医院肛肠外科,浙江绍兴312000 [2]绍兴第二医院检验科,浙江绍兴312000

出　　处：《中华医院感染学杂志》2012年第22期5038-5040,共3页Chinese Journal of Nosocomiology

摘　　要：目的了解肛周脓肿病原学分布及主要病原菌的耐药性,以指导临床应用抗菌药物,提高治疗疗效。方法于手术时取脓液做细菌培养,药敏试验采用K-B法,ESBLs检测采用纸片协同确证法。结果 2009年1月-2010年12月住院的113例患者标本细菌培养阳性82例,阳性率72.6%;共分离细菌125株,其中肠杆菌科细菌占60.8%,革兰阳性球菌占24.0%,非发酵菌占15.2%,混合感染占52.4%;大肠埃希菌(ECO)、肺炎克雷伯菌(KPN)和铜绿假单胞菌(PAE)对磺胺甲恶唑/甲氧苄啶耐药率为69.2%～80.0%、第三、四代头孢菌素为42.3%～73.3%;ECO和KPN对碳青霉烯类全部敏感,PAE则有40.0%菌株耐药;对含酶抑制剂复合药和阿米卡星的耐药率普遍较低;ESBLs检出率,ECO为38.5%,KPN为42.9%。结论肛周脓肿感染的病原菌以肠杆菌科细菌为主,且菌株的耐药率和ESBLs检出率均较高,临床应提高标本送检率,根据细菌培养、药敏试验及ESBLs检测的结果,合理选用或调整治疗用药,控制耐药菌的产生和播散。OBJECTIVE To study the distribution and antibacterial resistance of the pathogens causing perianal abscess,so as to guide the chinical use of antibiotics and improve treatment efficacy.METHODS We cultured the pus of perianal abscess and used the K-B method to test drug resistance and disc synergy confirmatory method to test ESBLs.RESULTS There were 82 patients who were cultured positive from the 113 hospitalized patients from Jan 2009 to Dec 2010,the positive rate was 72.6%;there were 125 strains of bacteria isolated,including Enterobacteriaceae（60.8%）,gram-positive cocci（24.0%）,and non-fermenting bacteria（15.2%）,the patients with mixed infections accounted for 52.4%;the drug resistance rates of Escherichia coli,Klebsiella pnenmoniae and Pseudomonas aeruginosa to sulfamethoxazole/trimethoprim ranged from 69.2% to 80.0%,the resistance rates to the third or fourth generation cephalosporins varied from 42.3% to 73.3%;E.coli and K.pneumoniae were sensitive to carbapenem,and there were 40.0% of P.aeruginosa strains that were resistant to antibiotics;the drug resistance rates to enzyme-containing inhibitor and amikacin were relatively low;the detection rates of ESBLs-producing E.coli and K.pneumoniae were 38.5% and 42.9%.CONCLUSION Enterobacteriaceae are the main pathogens causing perianal abscess infections,and the drug resistance rate of the strains is high and the detection rate of ESBLs-producing strains is also high;it is necessary for the clinic to raise the specimens submission rate and reasonably use antibiotics in accordance with the results of bacterial culture,drug suscepbility testing and the detection of ESBLs so as to prevent the prevalence of drug resistant strains.

关 键 词：肛周脓肿 病原学 耐药性 超广谱Β-内酰胺酶 

分 类 号：R181.32[医药卫生—流行病学]