摘要
目的研究分析肠瘘病发腹腔感染的危险因素及主要病原菌分布、常用抗菌药物的耐药性,以降低感染率。方法对2002年1-11月在医院就诊的肠瘘并发腹腔感染患者119例,留取患者的腹腔引流脓液等标本做培养,应用ABBott(MS-2System)系统做细菌鉴定及抗菌药物药敏试验,分析腹腔感染的细菌及其引起腹腔感染的危险因素和对抗菌药物耐药特点。结果肠瘘并发腹腔感染的病原菌主要为大肠埃希菌、屎肠球菌、铜绿假单胞菌、金黄色葡萄球菌、粪肠球菌、表皮葡萄球菌、肺炎克雷伯菌,分别占23.02%、7.19%、7.19%、7.19%、6.48%、6.84%、6.84%,其中革兰阴性菌占58.63%,革兰阳性菌占41.37%;革兰阴性菌超广谱β-内酰胺酶检出阳性率为46.01%,大肠埃希菌的耐药性高于肺炎克雷伯菌与阴沟肠杆菌,对阿米卡星、头孢哌酮、亚胺培南耐药性较低,并且亚胺培南(碳青霉烯类)显示了较强的抗菌作用;铜绿假单胞菌对阿米卡星、头孢哌酮、亚胺培南的耐药率<30.00%;鲍氏不动菌对头孢噻肟、头孢哌酮的耐药率<30.0%;嗜麦芽寡养单胞菌对环丙沙星耐药率为18.18%、头孢哌酮为36.36%;革兰阳性菌对替考拉宁与万古霉素耐药率均为0,金黄色葡萄球菌耐药率整体高于表皮葡萄球菌,金黄色葡萄球菌均为耐甲氧西林金黄色葡萄球菌;屎肠球菌整体耐药性高于粪肠球菌;对青霉素敏感的链球菌属对氨苄西林的耐药率较低,无耐万古霉素的菌株。结论肠瘘并发腹腔感染主要病原菌为革兰阴性菌,且ESBLs检出阳性率达46.0%;检出病原菌均呈现多药耐药性,因此对肠瘘并发腹腔感染的患者在更改引流方式等手术治疗外,需合理应用抗菌药物。
OBJECTIVE To study risk factors of parenteral fistula complicated with peritoneal infections and analyze the distribution of the main pathogens and the drug resistance to commonly used antibiotics so as to reduce the infection rate.METHODS A total of 119cases of intestinal fistula patients complicated with peritoneal infections,who were treated in the hospital from Jan to Oct 2002,were enrolled in the study,the abdominal drainage pus was sampled for bacterial culture,the ABBott（MS-2System）System was employed for the identification of bacteria and antibiotics susceptibility testing,then the risk factors for abdominal infections and the characteristics of drug resistance were analyzed.RESULTS Escherichia coli,Emterococcus faecium,Pseudomonas aeruginosa,Staphylococcus aureus,Enterococcus faecalis,Staphylococcus epidermidis,and Klebsiella pneumoniae were the main pathogens causing the parenteral fistula complicated with peritoneal infections,accounting for 23.02%,7.19%,7.19%,7.19%,6.48%,6.84%,and 6.84%,respectively;the gram-negative bacteria accounted for 58.63%,and the gram-positive bacteria accounted for 41.37%.The positive rate of the gram-negative bacteria to extended spectrumβ-lactamase was 46.01%,the drug resistance rate of E.coli was higher than that of K.pneumoniae and Enterobacter cloacae,the drug resistance rates to amikacin,cefoperazone,and imipenem were low,and imipenem showed highly antibacterial effect;the drug resistance rate of the P.aeruginosato amikacin,cefoperazone,and imipenem were less than 30.0%;the drug resistance rates of the A.baumannii to cefotaxime and cefoperazone were less than 30.0%;the drug resistance rate of Stenotrophomonas maltophilia to ciprofloxacin was 18.18%,cefoperazone 36.36%;the drug resistance rate of the gram-positive bacteria to teicoplanin was 0;the drug resist-ance rate of the S.aureus was higher than that of the S.epidermidis,and the drug resistance rate to rifampicin was 0,all the S.aureus strains were the methicillin-resistant S.aureus;the drug resistance rate of the E.faecium was higher than that of the E.faecalis;the drug resistance rate of the penicillin-sensitive Streptococcus to ampicillin was low,and the drug resistance rate to vancomycin was 0.CONCLUSIONThe gram-negative bacteria are the main pathogens causing the parenteral fistula complicated with peritoneal infections,the positive rate of ESBLs is up to 46.0%.In addition to the surgical treatment such as the change of drainage approach,it is necessary for the parenteral fistula patients complicated with peritoneal infections to reasonably use antibiotics.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2013年第16期3929-3931,共3页
Chinese Journal of Nosocomiology
关键词
肠瘘
腹腔感染
病原菌
耐药性
危险因素
分析
Parenteral fistula
Peritoneal infection
Pathogen
Drug resistance
Risk factor
Analysis
