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(P<0.05)。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。
Objective： To investigate the distribution and antimicrobial resistance of pathogens isolated from infections associated with acute necrotizing pancreatitis （ANP） and analyze their impacts on prognosis of the patients. Methods： The clinical data of 72 ANP patients complicated with infection admitted from October 2010 to October 2014 were retrospectively studied. Results： Of the 72 ANP patients, there were 47 cases （65.28%） with abdominal and retroperitoneal infection, 37 cases （51.39%） with respiratory infection, and 32 cases （44.44%） with bloodstream infection, and bloodstream infection was closely related to death of the patients （P〈0.05）. Of 235 pathogenic isolates, 159 （67.66%） were gram-negative bacteria, 60 （25.53%） were gram-positive bacteria and 16 （6.81%） were fungi, respectively. The top six common pathogens isolated were Acinetobacter baumanni （58 isolates, 24.68%）, Pseudomonas aeruginosa （21 isolates, 8.94%）, Klebsiella pneumonia （19 isolates, 8.09%）, Enterococcus faecium/faecalis （19 isolates, 8.09%）, Escherichia coli （18 isolates, 7.66%） and Staphylococcus aureus （11 isolates, 4.68%）, respectively. Antimicrobial susceptibility testing indicated that the resistant rate for Acinetobacter baumanni and Pseudomonas aeruginosa to imipeniem was 95.92% and 52.63%, and to cefperazone-sulbactam was 59.26% and 50.00%, respectively. The detection rate of extended-spectrum β-lactamases （ESBLs） in Klebsiella pneumonia and Escherichia coli was 64.29% and 80.00%, respectively. The resistance rate of Klebsiella pneumonia and Escherichia coli to cefperazone-sulbactam was 31.58% and 18.75%, and to imipeniem was 23.08% and 7.14%, respectively. Of the 19 isolates of Enterococcus faecium/faecalis, there was only one isolate resistant to vancomycin, and no linezolid-resistant isolate was found. The detection rate of Methicilin-resistant Staphylococcus aureus was 72.73%, and no isolate resistant to vancomycin, linezolid or macrodantin was noted. None of the 16 isolates was found resistant to common antifungal drugs. Conclusion： Bloodstream infection is an important cause for death in ANP patients. The gram-negative bacteria are still the major pathogens causing infections in ANP patients, however, the proportion of gram-positive bacteria and fungi should not be neglected. Multi-drug resistant bacteria have become an increasing challenge to the treatment of ANP associated with infections.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2015年第9期1285-1288,共4页
China Journal of General Surgery
关键词
胰腺炎
急性坏死性
感染
抗药性
微生物
Pancreatitis, Acute Necrotizing
Infection
Drug Resistance, Microbial
作者简介
杨慧明，中南大学湘雅医院硕士研究生，主要从事急性胰腺炎临床和基础方面的研究。
通信作者：黄耿文，Email：gengwenhuang@outlook．com
