普外科患者复杂腹腔感染的病原菌分布及药敏分析  

Distribution of pathogens causing complicated intra-abdominal infections in patients in general surgery and analysis of their drug sensitivity

作　　者：缪琦[1] 杜华劲[1] 高学键[1] 王仔平[1] 顾如兵[1] MIAO Qi;DU Hua-jin;GAO Xue-jian;WANG Zi-ping;GU Ru-bing(The First People's Hospital of Chuzhou City,Chuzhou,Anhui 239001,China)

机构地区：[1]安徽省滁州市第一人民医院,安徽滁州239001

出　　处：《中国病原生物学杂志》2021年第9期1064-1068,共5页Journal of Pathogen Biology

基　　金：安徽省卫生厅科研计划项目(No.ZY2014M022)。

摘　　要：目的分析普外科患者复杂腹腔感染的细菌分布特征及药物敏感性。方法2020年1月1日—2021年1月1日本院收治的复杂腹腔感染患者90例,按照不同治疗方案分为观察组和对照组,对两组患者进行腹腔穿刺引流,使用无菌拭子取少量脓液,接种血平板后置于37℃恒温微生物培养箱中进行病原菌的培养,对培养分离的致病菌进行菌种鉴定和药敏试验,分析患者感染病原菌的分布特点及耐药性,并比较两组患者治疗前后的炎症指标水平,评价两种治疗方案的临床疗效。结果90例复杂腹腔感染患者共培养出126株病原菌,其中革兰阴性菌79株,占62.60%,以大肠埃希菌、铜绿假单胞菌以及肺炎克雷伯菌为主;革兰阳性菌22株,占17.46%,以金黄色葡萄球菌和粪肠球菌为主;真菌25株,占19.84%,以白色念球菌为主。革兰阴性菌中以大肠埃希菌多见,共29株,占分离菌的23.02%,该菌对哌拉西林耐药率为93.10%,厄他培南耐药率为17.24%;铜绿假单胞菌对头孢吡肟和复方磺胺甲噁唑的耐药率为93.33%,环丙沙星和阿米卡星耐药率均为20.00%;肺炎克雷伯杆菌对15种抗生素的耐药率均在50.00%以上,其中对头孢唑林的耐药率达100.00%。革兰阳性菌中的金黄色葡萄球菌和粪肠球菌对万古霉素、利奈唑胺耐药率均为0;粪肠球菌对青霉素、左氧氟沙星、环丙沙星以及莫西沙星的耐药率为100.00%。与对照组比较,用药前两组患者WBC、CRP和PCT等炎症指标水平差异均无统计学意义(均P>0.05),用药7 d后观察组患者上述指标水平显著下调(均P<0.01)。对照组和观察组的临床治疗有效率分别为66.67%和80.00%,差异无统计学意义(P>0.05)。结论普外科患者复杂腹腔感染的病原菌种类多,以革兰阴性菌为主,单菌种以大肠埃希菌比例较高,且病原菌对常用抗生素的耐药率不同,需根据药敏试验结果合理选用耐药性低的抗菌药物治疗以提高临床疗效。Objective To analyze the distribution characteristics and drug sensitivity of the pathogens causing complicated intra-abdominal infections in patients in general surgery. Methods Ninety patients with a complicated intra-abdominal infection seen at this Hospital from January 1, 2020 to January 1, 2021 were divided into an observation group and a control group in accordance with different treatment plans. The two groups of patients underwent abdominal puncture and drainage, and sterile swabs were used. A small amount of pus was collected and used to inoculate a blood plate. The plate was placed in a microbial incubator with a constant temperature of 37 ℃ for pathogen culture. Strains were identified and a drug susceptibility test of the cultured and isolated pathogens was performed. The distribution characteristics and drug resistance of the pathogens infecting patients were analyzed. The levels of inflammatory indicators in the two groups of patients were compared before and after treatment, and the clinical efficacy of the two treatment options was evaluated. Results A total of 126 strains of pathogens were cultured from 90 patients with a complex intra-abdominal infection. Seventy-six strains(62.60%) were Gram-negative bacteria. Gram-negative bacteria were mainly Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Of the 126 total strains, 22(17.46%) were strains of Gram-positive bacteria. Gram-positive bacteria were mainly Staphylococcus aureus and Enterococcus faecalis. Of the 126 total strains, 25(19.84%) were strains of fungi. Fungi were mainly Candida albicans. E. coli was the most prevalent Gram-negative bacterium, with 29 strains accounting for 23.02% of the isolates. The resistance of that bacterium to piperacillin was 93.10%, and its resistance to ertapenem was 17.24%. The resistance of P. aeruginosa to cefepime and trimethoprim-sulfamethoxazole was 93.33%, and its resistance of ciprofloxacin and amikacin was 20.00%. K. pneumoniae was resistant to 15 antibiotics, with a resistance abo

关 键 词：复杂腹腔感染 病原菌 耐药性 普外科 临床疗效 

分 类 号：R378[医药卫生—病原生物学]