结直肠肿瘤患者手术分离易感菌株的药物敏感性分析  

Drug Susceptibility of Susceptible Strains Isolated from Surgical Samples of Patients with Colorectal Cancer

作　　者：魏雪[1] 黄红兵[1] 刘韬[1] 潘莹[1] 黄伟强[1] 刘庆[1] 

机构地区：[1]中山大学肿瘤防治中心,华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广州510060

出　　处：《中国医院用药评价与分析》2014年第2期139-141,共3页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：广东省科技计划项目(编号:2011B061300089)

摘　　要：目的：对不同手术方式组中分离的易感菌株的药物敏感性进行分析,并根据结果为临床提供选择围术期预防性应用抗菌药物方案,以减少耐药率,降低术后手术部位感染（SSI）的发生率.方法：对我院结直肠外科164例患者分离的易感菌株,用VITEK-32全自动微生物分析系统进行菌种鉴定,按临床和实验室标准协会（CLSI）制定的指导原则进行药物敏感性试验及结果判断.通过分析不同手术方式及不同细菌来源的药物敏感性情况,对药物敏感性试验结果进行统计和分析.结果：革兰阴性菌中产超广谱口-内酰胺酶（ESBL）菌株占33.2％ （115/346）,以产ESBL大肠埃希菌为主,占43.4％ （96/221）.在组织黏膜、腹腔液、引流液3组样本分离的大肠埃希菌株药物敏感性试验结果总体显示：对阿米卡星、头孢西丁、碳青霉烯类、含β-内酰胺酶药物敏感率较高,引流液分离菌株敏感率均在80％ ～ 100％.结论：样本主要分离以大肠埃希菌为主的革兰阴性菌,大肠埃希菌耐药率在3组样本中逐次增高与产ESBL大肠埃希菌分离率增加有关,产ESBL大肠埃希菌对第1—4代头孢菌素如头孢吡肟耐药率高,对阿米卡星、头孢西丁、含β-内酰胺酶药如哌拉西林/他唑巴坦、亚胺培南等碳青霉素类药敏感率较高.建议临床把现常用的第3代头孢菌素改用能同时覆盖肠杆菌科细菌和厌氧菌的头孢西丁等头霉素类药作为围术期预防用药品种.考虑手术部位存在厌氧菌株,必要时或与甲硝唑联用加强抗厌氧菌感染.OBJECTIVE：To analyze the drug sensitivity of the susceptible strains from different surgical groups of colorectal cancer patients and with the analytic results as reference to provide perioperative prophylactic antibiotic use regimens to reduce drug resistance and incidence of surgical site infection （SSI）.METHODS：The susceptible strains isolated from one hundred and sixty-four colorectal cancer patients were identified using VITEK-32 automatic microbiological analyzer,and drug susceptibility test was performed and the results were judged in accordance with the guiding principle issued by CLSI.The drug susceptibility test on different bacteria from different surgical procedure was analyzed statistically.RESULTS：33.2％ （115/346）of the isolated G-bacteria produced ESBLs,most of which were E.coli.（43.4％,96/221）.The E.coli from mucosal tissue,peritoneal fluid and fluid drainage samples were sensitive to Amikacin,Cefoxitin,Carbapenems and β-Lactamase-containing drugs and the susceptibility rates of the strains from fluid drainage all stood at 80％-100％.CONCLUSION：G-bacteria,mainly E.coli were the most commonly detected strain from three types of samples.The increase of drug resistance of E.coli in three samples in order（mucosa,intraoperative fluid to fluid one day after surgery）was associated with increasing in the isolating rate of ESBLs.ESBLs-producing E.coli were resistant to first,second,third and fourth generations of Cephalosporins but sensitive to Amikacin,Cefoxitin,β-Lactamase-containing drugs such as Piperacillin/Tazobactam,Imipenem and other CarbaDenems.It is advisable to use Cephamycins that are effective to Enterobacteriaceae and anaerobic bacteria such as Cefoxitin in the setting of perioperative prophylactic use.Metronidazole may be used concurrently if necessary in order to prevent anaerobic infection.

关 键 词：结直肠肿瘤 手术方式 围术期 易感菌株 药物敏感性 

分 类 号：R965[医药卫生—药理学]