重症急性胰腺炎合并感染的病原菌分布、耐药性及血清细胞因子表达意义  

Distribution and Drug Resistance of Pathogens,and Significance of Serum Cytokine Levels in Severe Acute Pancreatitis Complicated with Infection

作　　者：刘艳[1] 郭佩 张华[2] 张燕[3] Liu Yan;Guo Pei;Zhang Hua;Zhang Yan(Department of Emergency,Shanxi Provincial People's Hospital,Taiyuan 030012,China;Department of Gastroenterology,Shanxi Provincial People's Hospital,Taiyuan 030012,China;Department of Nephrology,Shanxi Provincial People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西省人民医院急诊科,太原030012 [2]山西省人民医院消化内科,太原030012 [3]山西省人民医院肾内科,太原030012

出　　处：《成都医学院学报》2024年第6期993-996,1000,共5页Journal of Chengdu Medical College

基　　金：山西省基础研究计划项目(No:20210302124612)。

摘　　要：目的探讨重症急性胰腺炎(SAP)合并感染的病原菌分布、耐药性及血清降钙素原(PCT)、正五聚蛋白3(PTX3)、细胞间黏附分子-1(ICAM-1)的表达意义。方法选取2023年1月至2024年1月山西省人民医院收治的334例SAP患者作为研究对象,其中合并感染的141例患者作为合并感染组(合并细菌感染组116例、合并真菌感染组25例),另外未合并感染的193例患者作为未合并感染组。分析SAP合并感染患者病原菌分布及主要菌株耐药情况,检测各组血清PCT、PTX3、ICAM-1水平。血清PCT、PTX3、ICAM-1水平与SAP合并感染的相关性采用Spearman相关性分析。结果141例SAP合并感染患者共培养出400株病原菌,占比较高的主要为革兰阴性菌,占比70.25%,其中主要包括阴沟肠杆菌、铜绿假单胞菌,占比分别为17.00%、14.00%,革兰阳性菌中占比较高的为金黄色葡萄球菌,占比7.50%。阴沟肠杆菌对庆大霉素、美洛西林、环丙沙星耐药严重,耐药率>70.00%,铜绿假单胞菌对美洛西林耐药严重,耐药率>80.00%,主要革兰阴性菌均对头孢噻肟耐药性低,耐药率<20.00%;金黄色葡萄球菌对万古霉素耐药严重,耐药率≥80.00%,主要革兰阳性菌均对克林霉素耐药性低,耐药率≤10.00%。与未合并感染组比较,合并细菌感染组、合并真菌感染组血清PCT、PTX3、ICAM-1水平更高,其中合并细菌感染组最高,差异有统计学意义(P<0.05)。Spearman相关性分析结果显示,血清PCT、PTX3、ICAM-1水平均与SAP合并感染呈正相关(r=0.815、r=0.795、r=0.833,P<0.05)。结论SAP合并感染患者主要感染病原菌为阴沟肠杆菌、铜绿假单胞菌和金黄色葡萄球菌,主要对头孢噻肟、克林霉素耐药性低,临床应合理选择针对性抗菌药物进行有效治疗;SAP患者血清PCT、PTX3、ICAM-1水平与SAP合并感染呈正相关,临床应密切关注。Objective To investigate the distribution and drug resistance of pathogens,and the significance of serum procalcitonin(PCT),pentraxin 3(PTX3)and intercellular adhesion molecule-1(ICAM-1)levels in severe acute pancreatitis(SAP)complicated with infection.Methods A total of 334 patients with SAP admitted to Shanxi Provincial People's Hospital from January 2023 to January 2024 were selected as the research objects.Among them,141 patients with infection were included in the co-infection group(116 patients with bacterial infection and 25 patients with fungal infection),and 193 patients without infection were included in the non-infection group.The distribution of pathogens and drug resistance of the main strains of pathogens of patients in the co-infection group were analyzed.The serum levels of PCT,PTX3 and ICAM-1 in each group were detected.The correlation between serum PCT,PTX3 and ICAM-1 levels and co-infection in SAP patients was analyzed by Spearman correlation analysis.Results A total of 400 strains of pathogens were cultured from the 141 patients in the co-infection group,of which Gram-negative bacteria accounted for 70.25%,including Enterobacter cloacae and Pseudomonas aeruginosa,accounting for 17.00%and 14.00%respectively,and Staphylococcus aureus accounted for 7.50%of the Gram-positive bacteria.Enterobacter cloacae was highly resistant to gentamicin,mezlocillin and ciprofloxacin,with a resistance rate of>70.00%.Pseudomonas aeruginosa was highly resistant to mezlocillin,with a resistance rate of>80.00%.All major Gram-negative bacteria showed low resistance to cefotaxime,with a resistance rate of<20.00%.Staphylococcus aureus was highly resistant to vancomycin,with a resistance rate of≥80.00%.And all major Gram-positive bacteria exhibited low resistance to clindamycin,with a resistance rate of≤10.00%.Compared with the non-infection group,the co-infection group showed higher serum PCT,PTX3 and ICAM-1 levels,among which the bacterial co-infection patients exhibited the highest serum PCT,PTX3 and ICAM-1 levels

关 键 词：胰腺炎 病原菌 耐药性 降钙素原 正五聚蛋白3 细胞间黏附分子-1 

分 类 号：R446.6[医药卫生—诊断学]