急性坏死性胰腺炎合并感染的病原菌及耐药性分析

发布时间：2018-12-10 08:35

【摘要】：目的:研究急性坏死性胰腺炎(ANP)合并感染的病原菌分布及耐药性,并探讨其对ANP患者预后的影响。方法:回顾性分析2010年10月—2014年10月收治的72例有明确病原学依据的ANP合并感染患者的临床资料。结果:72例ANP患者中,腹腔及腹膜后感染47例(65.28%),呼吸道感染37例(51.39%),血流感染32例(44.44%),其中血流感染与患者死亡密切相关(P0.05)。检出病原菌235株,其中革兰阴性细菌159株(67.66%),革兰阳性细菌60株(25.53%),真菌16株(6.81%)。获得的病原菌中排名前6位的依次是:鲍曼不动杆菌(24.68%),铜绿假单胞菌(8.94%),肺炎克雷伯菌(8.09%),屎肠球菌/粪肠球菌(8.09%),大肠埃希菌(7.66%),金黄色葡萄球菌(4.68%)。耐药性分析显示,鲍曼不动杆菌和铜绿假单胞菌对亚胺培南耐药率分别达95.92%和52.63%,对头孢哌酮/舒巴坦的耐药率分别为59.26%和50.00%。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs)检出率分别为64.29%和80.00%,对头孢哌酮/舒巴坦的耐药率分别为31.58%和18.75%,而对亚胺培南的耐药率分别为23.08%和7.14%。19株屎肠球菌/粪肠球菌中仅1株对万古霉素耐药,对利奈唑烷尚未发现耐药菌株。耐甲氧西林金黄色葡萄球菌检出率为72.73%,对万古霉素、利奈唑烷和呋喃妥因尚未发现耐药菌株。16株真菌对常用抗真菌药物均未发现耐药菌株。结论:血流感染是ANP患者死亡的重要原因。ANP患者的病原菌仍以革兰阴性菌为主,但革兰阳性菌和真菌的比例不容忽视。多重耐药菌已成为ANP合并感染的巨大的挑战。
[Abstract]:Objective: to study the distribution and drug resistance of pathogenic bacteria in acute necrotizing pancreatitis (ANP) complicated with (ANP) infection, and to explore its influence on the prognosis of ANP patients. Methods: the clinical data of 72 patients with ANP complicated with infection from October 2010 to October 2014 were retrospectively analyzed. Results: there were 47 cases (65.28%) of abdominal and retroperitoneal infection, 37 cases (51.39%) of respiratory tract infection and 32 cases (44.44%) of blood flow infection. 235 strains of pathogenic bacteria were detected, of which 159 were Gram-negative bacteria (67.66%), 60 were Gram-positive bacteria (25.53%), and 16 were fungi (6.81%). Acinetobacter baumannii (24.68%), Pseudomonas aeruginosa (8.94%), Klebsiella pneumoniae (8.09%), Enterococcus faecium / Enterococcus faecalis (8.09%) were the leading pathogens. Escherichia coli (7.66%), Staphylococcus aureus (4.68%). The drug resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa to imipenem were 95.92% and 52.63%, respectively, and those to cefoperazone / sulbactam were 59.26% and 50.002%, respectively. The detection rate of extended-spectrum 尾 -lactamases (ESBLs) in Klebsiella pneumoniae and Escherichia coli was 64.29% and 80.005, respectively. The resistance rates to cefoperazone / sulbactam were 31.58% and 18.75%, respectively. But the resistance rates to imipenem were 23.08% and 7.14.19 strains of Enterococcus faecium / Enterococcus faecalis only one strain was resistant to vancomycin. The detection rate of methicillin-resistant Staphylococcus aureus was 72.73. No resistant strains were found to vancomycin, linazolidine and furantoin. Conclusion: blood flow infection is an important cause of death in patients with ANP. Gram-negative bacteria are still the main pathogens in ANP patients, but the ratio of Gram-positive bacteria to fungi can not be ignored. Multidrug resistant bacteria (MDR) have become a major challenge for ANP co-infection.
【作者单位】：中南大学湘雅医院普外胰胆外科;
【分类号】：R446.5;R576

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