细菌性肝脓肿102例病原菌分布及耐药性分析  

Analysis of pathogen distribution and drug resistance with bacterial liver abscess:102 cases

作　　者：吕倩 王伟[2] 赖晓全 韩颖[1] LYU Qian;WANG Wei;LAI Xiaoquan;HAN Ying(Department of Hospital Infection Control,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China;Department of Hepatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院感染管理科,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院肝脏外科,湖北武汉430030

出　　处：《安徽医药》2021年第2期254-257,共4页Anhui Medical and Pharmaceutical Journal

基　　金：国家自然科学基金项目(71473098)。

摘　　要：目的探讨某医院细菌性肝脓肿病人的病原菌分布,结合耐药性分析,为临床经验性使用抗菌药物提供理论依据。方法回顾性分析华中科技大学同济医学院附属同济医院2017年1月至2019年6月收治的102例肝脓肿病人的临床资料、病原学检查及药敏试验结果。结果102例肝脓肿病人存在的基础疾病以肝脏肿瘤(49.32%)、胆道疾病(28.77%)和糖尿病(13.70%)为主。检出的病原菌中,革兰阴性杆菌以肺炎克雷白杆菌(25.51%)和大肠埃希菌(15.44%)为主,对氨苄西林、头孢呋辛、头孢噻肟、哌拉西林、头孢唑林耐药率均大于80%,肺炎克雷白杆菌对米诺环素和替加环素耐药率低,大肠埃希菌对头孢哌酮/舒巴坦、美罗培南、亚胺培南、米诺环素和替加环素耐药率较低。革兰阳性球菌以屎肠球菌(17.45%)为主,对青霉素、红霉素、氨苄西林/舒巴坦、左氧氟沙星和环丙沙星耐药率大于90%,对万古霉素、替加环素、利奈唑胺和替考拉宁耐药率低。结论导致细菌性肝脓肿的病原菌以肠杆菌科细菌为主,早期经验性选择抗菌药物应根据肝脓肿病人耐药性分析尽可能选择相对敏感的抗菌药物,为避免广谱抗菌药物的长期应用造成细菌耐药和二重感染,应根据微生物检测结果及时调整抗生素。Objective To investigate the distribution of pathogenic bacteria in patients with bacterial liver abscess in a hospital,and to provide a theoretical basis for clinical empirical use of antibacterial drugs in combination with drug resistance analysis.Methods The clinical data,etiology and drug sensitivity test results of 102 patients with liver abscess treated in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2017 to June 2019 were retrospectively analyzed.ResultsThe basic diseases in 102 patients with liver abscess were mainly liver tumors(49.32%),biliary diseases(28.77%)and diabetes(13.70%).Among the detected pathogens,gram-negative bacteria were mainly Klebsiella pneumoniae(25.51%)and Escherichia coli(15.44%).The resistance rates of ampicillin,cefuroxime,cefotaxime,piperacillin,and cefazol were above 80%.The resistance rates of Klebsiella pneumoniae to minocycline and tigecycline were low.Escherichia coli against cefoperazone/sulbactam,meropenem,imipenem,Minocycline and tigecycline have lower resistance rates.Gram-positive cocci are mainly Enterococcus faecium(17.45%),the resistance rates to penicillin,erythromycin,ampicillin/sulbactam,levofloxacin and ciprofloxacin were above 90%,but it had lower resistance rates to vancomycin,tigecyclin,elinezolid and teicoplanin.Conclusions The pathogenic bacteria that cause bacterial liver abscess are mainly Enterobacteriaceae.Early empirical selection of antibacterial drugs should be based on the analysis of drug resistance in patients with liver abscess.As far as possible,relatively sensitive antibacterial drugs should be selected to avoid the long-term application of broad-spectrum antibacterial drugs.Antibiotic resistance and secondary infection should be adjusted in time according to the results of microbial testing.

关 键 词：肝脓肿 化脓性 病原菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R575.4[医药卫生—临床医学]