肝胆胰腺肿瘤患者术后感染的病原菌分布及药敏分析

发布时间：2018-12-11 22:11

【摘要】：目的:本文通过回顾性研究肝胆胰腺肿瘤患者术后发生感染收集的标本进行细菌培养及药敏分析,明确肝胆胰腺肿瘤术后感染患者的病原菌分布及耐药性情况,为术后感染合理使用抗生素提供依据。方法:收集河北医科大学第四医院东院肝胆外科2013年1月-2016年9月肝胆胰腺肿瘤病人,针对术后发生感染的标本进行细菌培养及药敏试验,统计分离出的感染细菌类别,并对分离出主要的几种病原菌作为研究对象,对其常用抗生素的耐药性进行分析。细菌鉴定和抗生素药敏试验使用BD Phoenix全自动细菌鉴定及药敏分析仪,按照CLSI 2016年版的标准判断结果,以敏感(S)、中介(I)、耐药(R)进行区分。结果:1病原菌标本来源:病原菌标本来源以腹腔引流液为主,占93%,其他占7%;2病原菌分布及构成比:从2013年1月~2016年9月收集术后发生感染的78人,共有124份培养出病原菌,培养出16种细菌,4种真菌,其中有13份标本中检出细菌合并真菌。分离出的病原菌包括革兰氏阴性菌72份(52.55%),革兰氏阳性菌47份(34.31%),真菌18份(13.14%)。革兰氏阴性菌主要包括肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌、铜绿假单胞菌、鲍曼氏不动杆菌,分别占总病原菌数13.87%、10.95%、10.95%、4.38%和2.92%,革兰氏阳性菌主要包括屎肠球菌、金黄色葡萄球菌及粪肠球菌,分别占总病原菌数12.41%、8.03%及6.57%,真菌以白色念珠菌为主,占总病原菌数10.95%;3革兰阴性细菌对常用抗生素的敏感率或耐药率:革兰阴性菌以杆菌为主,对碳青霉烯类如亚胺培南、美罗培南敏感,对丁胺卡那霉素也有很高的敏感性,对青霉素类及头孢类具有较高的耐药性;4革兰阳性细菌对常用抗生素的敏感率或耐药率:革兰阳性菌以球菌为主,对万古霉素、利奈唑烷、替考拉宁等药物具有较高敏感性,对青霉素类、喹诺酮类及头孢类有较高的耐药性;5真菌对伏立康唑较为敏感。结论:1肝胆胰腺肿瘤手术治疗后导致感染的致病菌种以革兰阴性菌为主,而其中肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌所致感染最多,对碳青霉烯类及丁胺卡那霉素较为敏感。2革兰阳性菌以屎肠球菌及溶血葡萄球菌所占比例最高,对万古霉素、利奈唑烷及替考拉宁等药物具有较高敏感性。3真菌以白色念球菌为主,对伏立康唑较为敏感。
[Abstract]:Objective: to investigate the distribution of pathogenic bacteria and drug resistance in patients with hepatopancreatic neoplasms after operation by retrospectively studying the bacterial culture and drug sensitivity of the specimens collected from patients with hepatobiliary and pancreatic neoplasms. To provide the basis for rational use of antibiotics for postoperative infection. Methods: from January 2013 to September 2016, patients with hepatobiliary and pancreatic neoplasms in the Eastern Hospital of the fourth Hospital of Hebei Medical University were collected for bacterial culture and drug sensitivity test. Several main pathogens were isolated as the research object, and the antibiotic resistance of common antibiotics was analyzed. BD Phoenix automatic bacterial identification and antibiotic susceptibility test were used to identify the bacteria and the drug sensitivity analyzer. According to the standard judgment results of CLSI 2016 edition, the sensitive (S), intermediate (I), resistant (R) was distinguished. Results: (1) the origin of pathogenic bacteria: the main source of pathogenic bacteria was peritoneal drainage fluid (933%) and the other 7 (7%). (2) the distribution and composition of pathogenic bacteria: from January 2013 to September 2016, a total of 78 patients with postoperative infection were collected. A total of 124 pathogens were cultured, 16 kinds of bacteria and 4 kinds of fungi were cultured, of which 13 samples were found to have bacteria combined with fungi. The pathogens isolated included 72 Gram-negative bacteria (52.55%), 47 Gram-positive bacteria (34.31%) and 18 fungi (13.14%). Gram-negative bacteria mainly included Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Pseudomonas aeruginosa and Acinetobacter baumannii, which accounted for 13.87% and 2.92% of the total pathogenic bacteria, respectively. Gram-positive bacteria mainly included Enterococcus faecium, Staphylococcus aureus and Enterococcus faecalis, which accounted for 12.41% and 6.57% of the total pathogenic bacteria, respectively. The fungi were mainly Candida albicans, which accounted for 10.95% of the total pathogenic bacteria. 3 susceptibility or resistance of Gram-negative bacteria to common antibiotics: Gram-negative bacteria are mainly bacilli, sensitive to carbapenem such as imipenem, meropenem, and highly sensitive to amikacin. It has high resistance to penicillin and cephalosporins. 4 the susceptibility or drug resistance rate of Gram-positive bacteria to common antibiotics: Gram-positive bacteria were mainly cocci and highly sensitive to vancomycin, linazolane, teicoplanin, and penicillin. Quinolones and cephalosporins have higher resistance; 5 Fungi were sensitive to voliconazole. Conclusion: (1) Gram-negative bacteria were the main pathogenic bacteria of hepatobiliary and pancreatic tumor after operation, among which Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae were the most common. Gram-positive bacteria accounted for the highest proportion of Enterococcus faecium and Staphylococcus haemolyticus, while vancomycin was the most sensitive to carbapenem and amikacin. (3) the fungi were mainly Candida albicans and were sensitive to voleconazole.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735

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