糖尿病合并细菌性肝脓肿的病原菌特征及耐药性分析  

Pathogenic bacteria and drug resistance in patients with diabetes mellitus and bacterial liver abscess

作　　者：李佳[1] 唐秀英[1] 谭金哲[2] 袁岚[1] LI Jia;TANG Xiu-ying;TAN Jin-zhe;YUAN Lan(Infectious Disease Center,West China Hospital,Sichuan University,Chengdu 610041,China;Medical Laboratory,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院感染性疾病中心,四川成都610041 [2]四川大学华西医院实验医学科,四川成都610041

出　　处：《实用医院临床杂志》2018年第6期58-60,共3页Practical Journal of Clinical Medicine

摘　　要：目的探讨糖尿病(DM)合并细菌性肝脓肿的病原菌特征及耐药性,为合并细菌性肝脓肿患者的临床诊治提供依据。方法 2016年1月至2018年4月我科确诊的70例DM合并细菌性肝脓肿患者,收集其临床相关资料,分析并发细菌性肝脓肿的原因,并进行病原菌培养与药敏分析。结果 70例合并细菌性肝脓肿的DM患者发病原因依次为胆管疾病(45. 71%)、呼吸道感染(28. 57%)及隐匿性感染(25. 71%)。本次共检出病原菌70株,以革兰阴性菌为主(81. 43%),包括肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌、铜绿假单胞菌;革兰阳性菌较少(18. 57%),包括金黄色葡萄球菌、粪肠球菌、草绿色链球菌等。主要革兰阴性菌肺炎克雷伯菌、大肠埃希菌对亚胺培南、阿米卡星均较敏感,耐药率均低于20%;而对氨苄西林、环丙沙星不敏感,耐药率较高,均超过85%,对其他抗菌药物敏感性一般。主要革兰阳性菌金黄色葡萄球菌对万古霉素敏感,耐药率为0;而对青霉素、头孢唑林不敏感,耐药率超过85%。结论胆管疾病、呼吸道感染、隐匿性感染均可导致DM患者发生细菌性肝脓肿,此并发症病原菌以革兰阴性菌为主,应根据病原菌特征和耐药性合理选择抗菌药物治疗。To analyze the pathogenic bacteria and drug resistance in patients with diabetes mellitus(DM)and bacterial liver abscess in order to provide the basis for the clinical diagnosis and treatment of patients with bacterial liver abscess.A total of 70 DM patients with bacterial liver abscesses diagnosed in our hospital during the period from January 2016 to April 2018 were selected and their clinical data were collected to analyze the causes of bacterial liver abscesses.The pathogenic bacteria culture and drug sensitivity analysis were performed.The causes of the 70 DM patients with bacterial liver abscesses were bile duct disease(45.71%),respiratory infection(28.57%)and occult infection(25.71%).A total of 70 strains of pathogenic bacteria were detected,and the majority was gram-negative bacteria(81.43%),including Klebsiella pneumoniae,Escherichia coli,Acinetobacter baumannii and Pseudomonas aeruginosa.Gram-positive bacteria were fewer(18.57%),including Staphylococcus aureus,Enterococcus faecalis and Streptococcus viridans,etc.The main gram-negative bacteria Klebsiella pneumoniae and Escherichia coli were sensitive to imipenem and amikacin,and the drug resistance rates were all lower than 20%.However,they were not sensitive to ampicillin or ciprofloxacin,and the drug resistance rates were higher than 85%.The sensitivity to other antibiotics was generally low.The main gram-positive bacteria Staphylococcus aureus was sensitive to vancomycin,and the resistance rate was 0 while it was not insensitive to penicillin or cefazolin,and the resistance rate was over 85%.Bile duct diseases,respiratory infections and occult infections can cause bacterial liver abscesses in patients with DM.Gram-negative bacteria are the main pathogens causing the complication.Antibiotics should be selected reasonably according to the characteristics of pathogens and drug resistance.

关 键 词：糖尿病 细菌性肝脓肿 病原菌 耐药 

分 类 号：R587.1[医药卫生—内分泌] R575.4[医药卫生—内科学]