摘要
目的探究腹腔感染患者腹腔引流液中病原菌分布及其耐药性情况.方法选择2015-01/2017-11天津市宁河区医院就诊并行腹腔引流术的腹腔感染患者92例进行回顾性分析,统计患者的腹腔引流液细菌培养和药敏结果 ,分析不同菌群和耐药性的差异,并应用Cox回归分析模型探究影响患者预后的独立危险因素.结果共培养出菌株145例,其中革兰氏阳性菌44株、革兰氏阴性菌97株和真菌4株;大肠埃希菌(31.72%),肺炎克雷伯杆菌(24.14%),金黄色葡萄球菌(15.86%),肠球菌属(11.72%),铜绿假单胞菌(7.59%)的构成比较高.金黄色葡萄球菌和肠球菌属的耐药率较高,但均对万古霉素高度敏感;其中,肠球菌属对红霉素、氯霉素、左氧氟沙星的耐药率高于金黄色葡萄球菌,金黄色葡萄球菌对氨苄青霉素的耐药性较高.G-菌属均存在较高的耐药率,但均对β-内酰胺类/β-内酰胺酶(extended-spectrumβ-lactamase,ESBLs)抑制剂、亚胺培南/西司他丁和阿米卡星具有较高的敏感性;其中,超广谱ESBLs+的菌属以及铜绿假单胞菌对头孢曲松、头孢他啶、头孢吡肟和左氧氟沙星的耐药率较高.多因素Cox回归分析显示,多重耐药菌(multi drug resistance bacteria,MDRO)、ESBLs+和发热至培养时间是腹腔感染患者死亡的独立危险因素.结论腹腔感染患者腹腔引流液中病原菌分布以革兰氏阴性菌为主,且病原菌对常用抗菌素具有较高的耐药性,MDRO、ESBLs+和发热至培养时间是腹腔感染患者死亡的独立危险因素.
AIM To identify the pathogenic bacteria in abdominal cavity drainage of patients with intraabdominal infection and to analyze their drug resistance.From January 2015 to November 2017, 92 patients with intraperitoneal infection were treated by celiac drainage at our hospital. The bacterial culture and drug susceptibility results of peritoneal drainage fluid were statistically analyzed, and the differences in different bacterial populations and drug resistance were analyzed. Cox regression model was used to explore the independent risk factors affecting the prognosis of patients.RESULTS A total of 145 bacterial strains were cultured, including 46 Gram-positive and 97 Gram-negative strains. The top five pathogens were Escherichia coli （31.72%）, Klebsiellosis pneumoniae （24.14%）, Staphylococcus aureus （15.86%）, Enterococcus （11.72%）, and Pseudomonas aeru- ginosa （7.59%）. Staphylococcus aureus and Enterococcus were two Gram-positive strains that had high resis- tance rates but were highly sensitive to vancomycin. Enterococci had high resistance rates to erythromycin, chloramphenicol, and levofloxacin than Staphylococcus aureus, which had a high resistance rate to ampicillin. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeru- ginosa, and other three kinds of G-bacteria had high resistance rates, but all of them had a high sensitivity to ^-lactams/^-lactamase inhibitors, imipenem/Cistadine and amikacin; among them, extended spectrum beta lactamase （ESBL） producing strains and Pseudomonas aeruginosa had high resistance rates to ceftriaxone, ceftazidime, cefepime, and levofloxacin. Univariate Cox regression analysis showed that age, multidrug resistant organism （MDRO）, nosocomial infection, ESBL positivity, and time from fever to culture were related to death in patients with intraabdominal infection. Multivariate Cox regression analysis showed that MDRO,ESBL positivity, and time from fever to culture were independent risk factors for death in patients with intraabdominal infection.CONC
作者
魏寒松
Han-Song Wei(Department of Laboratory Medicine, Ninghe District Hospital of Tianjin, Tianjin 301500, China)
出处
《世界华人消化杂志》
CAS
2018年第9期550-556,共7页
World Chinese Journal of Digestology
关键词
腹腔感染
腹腔引流
细菌培养
多重耐药菌
Intraabdominal infection
Abdominal drainage
Bacterial culture
Multiple drug-resistant bacteria
