肠瘘并发腹腔感染患者的致病菌类别临床分析  

Clinical analysis of pathogenic bacterial infection in patients with intestinal fistula complicated with abdominal infection

作　　者：李军[1] 王励之 王江[1] 陈超武[1] Li Jun;Wang Lizhi;Wang Jiang;Chen Chaowu(Hunan Provincial People's Hosipital(The First Affliated Hospital of Hunan Normal University),Changsha,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)

出　　处：《实用休克杂志(中英文)》2024年第5期309-312,共4页Journal of Practical Shock

基　　金：湖南省自然科学基金项目(项目编号:2019JJ50321)

摘　　要：目的通过对病原菌培养阳性的肠瘘并发腹腔感染患者的感染情况、病原菌菌种分布及耐药性进行临床分析,总结肠瘘患者腹腔感染的临床特点、菌种分布及耐药特点,从而更好地指导临床早期精准使用抗生素。方法回顾性分析2022年1月至2024年6月本院收治外院转入的腹部手术后肠瘘并发腹腔感染且腹水或引流液病原菌培养阳性的患者病例资料,计算病原菌菌种构成比和耐药率,分析其感染特点和耐药现状。结果检出的病原菌以肺炎克雷伯菌和大肠埃希菌为主,分别占比25%和17.3%,其次是屎肠球菌,占比15.4%,白色念珠菌占比13.5%。肺炎克雷伯菌和大肠埃希菌对碳青霉烯类药物敏感,对喹诺酮类耐药率高;屎肠球菌对万古霉素、利奈唑胺等多种药物敏感,对喹诺酮类、克林霉素、红霉素耐药率高。白色念珠菌的检出率较以往明显升高,对常用抗真菌药物敏感。结论肠瘘并发腹腔感染患者病原菌培养的耐药菌以及真菌检出率较以往升高,合理的抗菌药物应用和及时控制感染源是治疗肠瘘并发腹腔感染的关键。Objective Through the clinical analysis of the infection situation,pathogen strain distribution and drug resistance of patients with intestinal fistula complicated by peritoneal infection with positive bacterial culture,the clinical characteristics,strain distribution and drug resistance of intestinal fistula patients were summarized,so as to better guide the accurate use of antibiotics in early clinical stage.Methods The case data of patients with postoperative intestinal fistula complicated with peritoneal infection and positive bacterial culture in ascites or drainage fluid admitted to Hunan People's Hospital from January 2022 to June 2024 were retrospectively analyzed.The bacterial species composition ratio and drug resistance rate of thepathogenic bacteria were calculated,and the infection characteristics and drug resistance status were analyzed.Results Klebsiella pneumoniae and Escherichia coli were the main pathogens detected,accounting for 25%and 17.3%respectively,followed by Enterococcus faecium,accounting for 15.4%,Candida albicans accounted for 13.5%.Klebsiella pneumoniae and Escherichia coli were sensitive to carbapenems and had high resistance to quinolones.Enterococcus faecium was sensitive to vancomycin,linezolid and other drugs,and had high resistance rate to quinolones,clindamycin and erythromycin.The detection rate of Candida albicans was significantly higher than before,and it was sensitive to common antifungal drugs.Conclusions The detection rate of drug-resistant bacteria and fungi in the pathogenic bacteria culture of patients with intestinal fistula complicated with abdominal infection was higher than before.Rational application of antibiotics and timely control of infection sources are the key to the treatment of intestinal fistula complicated with abdominal infection.

关 键 词：肠瘘 腹腔感染 耐药菌 合理用药 

分 类 号：R656[医药卫生—外科学] R446.5[医药卫生—临床医学]