摘要
目的探讨细菌性肝脓肿患者病原菌与耐药性及治疗效果,以指导临床用药。方法回顾性分析2017年1月-2019年12月细菌性肝脓肿患者96例的临床资料,分析肝脓肿穿刺脓液或血培养标本的结果、病原菌鉴定及药敏试验的资料。收集所有患者治疗方案及预后资料。结果共培养分离病原菌99株,其中革兰阴性菌87株占87.88%,革兰阳性菌12株占12.12%。单一细菌感染93例,以肺炎克雷伯菌,大肠埃希菌感染为主;双重细菌感染3例:肺炎克雷伯菌+大肠埃希菌1例,肺炎克雷伯菌+金黄色葡萄球菌1例,肺炎克雷伯菌+奇异变形杆菌1例。肺炎克雷伯菌对氨苄西林完全耐药,对哌拉西林、头孢唑林、头孢噻肟、哌拉西林/他唑巴坦、氨曲南、庆大霉素、环丙沙星、左氧氟沙星、磺胺甲噁唑/甲氧苄啶的耐药率<30%,对头孢替坦、头孢哌酮/舒巴坦、妥布霉素、阿米卡星、亚胺培南、美罗培南、替加环素敏感。大肠埃希菌对氨苄西林的耐药率≥75%,对头孢唑林、环丙沙星的耐药率≥50%,对哌拉西林、头孢噻肟、氨曲南、庆大霉素、左氧氟沙星、磺胺甲噁唑/甲氧苄啶的耐药率≥30%,对头孢替坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、妥布霉素、阿米卡星的耐药率<30%,对亚胺培南、美罗培南、替加环素敏感。抗菌药物治疗:β-内酰胺类使用率为77.08%,氨基糖苷类使用率为6.25%,碳青霉烯类使用率为67.71%,喹诺酮类使用率为26.04%,万古霉素使用率为2.08%。三组不同方法治疗疗效差异无统计学意义(P=0.926)。结论肺炎克雷伯菌是细菌性肝脓肿的主要致病菌,对大多数β-内酰胺类、碳青霉烯类、喹诺酮类抗菌药敏感;次要致病菌为大肠埃希菌,对部分β-内酰胺类、氨基糖苷类、喹诺酮类抗菌药有耐药性,对碳青霉烯类抗菌药敏感。临床应根据药敏试验合理选择抗菌药物,才能达到满意的治疗效果,是否辅助肝脓
OBJECTIVE To investigate the pathogenic bacteria, drug resistance and therapeutic effects of patients with bacterial liver abscess, so as to guide clinical medication. METHODS The clinical data of 96 patients with bacterial liver abscess from Jan. 2017 and Dec. 2019 were retrospectively analyzed, and the data of the culture of liver abscess puncture pus or blood culture specimens, pathogen identification and drug sensitivity test were analyzed. The treatment plan and prognostic data of all patients were collected. RESULTS A total of 99 strains were co-cultivated and isolated, including 87 strains of Gram-negative bacteria(87.88%) and 12 strains of Gram-positive bacteria(12.12%). There were 93 cases with single bacterial infection which was mainly caused by Klebsiella pneumoniae and Escherichia coli, 3 cases with double bacterial infections(1 infected by K. pneumoniae and E. coli, 1 by K. pneumoniae and S. aureus, 1 by K. pneumoniae and P. mirabilis). K. pneumoniae was completely resistant to ampicillin, the resistance rates to piperacillin, cefazolin, cefotaxime, piperacillin/tazobactam, aztreonam, gentamicin, ciprofloxacin, levofloxacin and sulfamethoxazole/trimethoprim were less than 30%, while Klebsiella was sensitive to cefotetan, cefoperazone/sulbactam, tobramycin, amikacin, imipenem, meropenem and tigecycline. The resistance rate of E. coli to ampicillin was not lower than 75%, to cefazolin and ciprofloxacin were not lower than 50%, to piperacillin, cefotaxime, aztreonam, gentamicin, levofloxacin and sulfamethoxazole/trimethoprim were not lower than 30%, to cefotetan, piperacillin/tazobactam, cefoperazone/sulbactam, tobramycin and amikacin were lower than 30%, and it was sensitive to imipenem, meropenem and tigecycline. For treatment with antibacterial agents, the use rates of β-lactams, aminoglycosides, carbapenems, quinolones and vancomycin were 77.08%, 6.25%, 67.71%, 26.04% and 2.08%, respectively. There were no significant difference in the curative effect among the three groups(P=0.926). CONCLUSION K.
作者
吴元清
林杰
邱堃
张敏
吴才标
WU Yuan-qing;LIN Jie;QIU Kun;ZHANG Min;WU Cai-biao(Second People's Hospital of Hainan Province,Wuzhishan,Hainan 572299,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2021年第3期413-418,共6页
Chinese Journal of Nosocomiology
基金
海南省医药卫生科研基金资助项目(4602252020006)。
关键词
细菌性肝脓肿
药敏试验
病原菌
耐药
治疗效果
Bacterial liver abscess
Drug sensitivity test
Pathogenic bacteria
Drug resistance
Therapeutic effect
