摘要
目的:分析腹腔感染患者腹腔标本中分离菌株的分布及对抗菌药物的耐药情况,为临床抗感染经验性治疗及合理使用抗菌药物提供依据。方法:回顾性分析2017年1月—2021年12月在西宁市第三人民医院住院的腹腔感染患者送检的胆道分泌物、胰腺分泌物、阑尾分泌物、腹水标本中分离菌株及耐药情况。结果:在所有送检的腹腔感染标本中共分离出细菌970株,其中革兰阴性杆菌731株,占75.36%,革兰阳性球菌239株,占24.64%;腹腔感染单一菌引起的感染638例,占79.35%,两种菌感染166例,占20.65%。革兰阴性杆菌是腹腔感染的主要分离菌株,以大肠埃希菌、肺炎克雷伯菌为主,腹腔感染革兰阳性球菌以肠球菌属细菌、金黄色葡萄球菌为主。产超广谱β-内酰胺酶(ESBLs)在大肠埃希菌中检出率为34.61%,在肺炎克雷伯菌中检出率为21.15%,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为32.26%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为23.81%。大肠埃希菌、肺炎克雷伯菌对氨苄西林、哌拉西林、头孢唑林、环丙沙星耐药率均>40%,未发现对碳青霉烯类药物的耐药菌株。粪肠球菌和屎肠球菌对高浓度庆大霉素、高浓度链霉素、环丙沙星、左氧氟沙星的耐药率均>40%,金黄色葡萄球菌对阿奇霉素、克林霉素的耐药率均≥30%,未发现对万古霉素、利奈唑胺和替考拉宁的耐药菌株。结论:腹腔感染细菌以大肠埃希菌、肺炎克雷伯菌、粪肠球菌和金黄色葡萄球菌为主,ESBLs、MRSA和MRCNS检出率较高,应加强对腹腔感染患者细菌耐药性监测和流行病学调查,根据药敏试验结果合理使用抗菌药物,以延缓细菌的耐药率。
Objective:To analyze the distribution and antimicrobial resistance of bacterial strains isolated from patients with intra-abdominal infection,and to provide evidence for clinical empirical treatment of anti-infection and rational use of antibiotics.Method:The isolated strains and drug resistance in biliary tract secretion,pancreatic secretion,appendiceal secretion and ascites samples of patients with intra-abdominal infection hospitalized in the Third People's Hospital of Xining from January 2017 to December 2021 were retrospectively analyzed.Result:A total of 970 strains of bacteria were isolated from all samples of abdominal infection,including 731 strains of Gram-negative bacilli accounted for 75.36%,239 strains of Gram-positive cocci,accounting for 24.64%;638 cases of abdominal infection caused by single bacteria,accounting for 79.35%,166 cases were infected with two kinds of bacteria,accounting for 20.65%.Gram-negative bacilli were the main isolates of abdominal infection,mainly Escherichia coli and Klebsiella pneumoniae.Gram-positive bacteria of abdominal infection were mainly Enterococcus and Staphylococcus aureus.The detection rate of extended-spectrumβ-lactamase(ESBLs)was 34.61%in Escherichia coli,21.15%in Klebsiella pneumoniae,32.26%in methicillin-resistant Staphylococcus aureus(MRSA)and 23.81%in methicillin-resistant coagulase-negative staphylococcus(MRCNS).The resistance rates of Escherichia coli and Klebsiella pneumoniae to Ampicillin,Piperacillin,Cefazolin and Ciprofloxacin were all higher than 40%,and no carbapenem resistant strains were found.The resistance rates of Enterococcus faecalis and Enterococcus faecium to high concentrations of Gentamicin,high concentrations of Streptomycin,Ciprofloxacin and Levofloxacin were all>40%.The resistance rates of Staphylococcus aureus to Azithromycin and Clindamycin were all≥30%.No drug-resistant strains to Vancomycin,Linezolid and Teicoplanin were found.Conclusion:Bacterial infections in intra-abdominal are mainly Escherichia coli,Klebsiella pneumoniae,Enterococcus faecalis and Staphylococcus aureus.The detection rates of ESBLs,MRSA and MRCNS are high,surveillance and epidemiological investigation of bacterial resistance in patients with intra-abdominal infection are necessary,and rationally use antibiotics according to the results of drug sensitivity test to delay the drug resistance rate of bacteria.
作者
高延可
常璠
蒋国梅
李美玲
纪荣祖
GAO Yanke;CHANG Fan;JIANG Guomei;LI Meiling;JI Rongzu(The Third People's Hospital of Xining,Xining 810005,China;不详)
出处
《中国医学创新》
CAS
2023年第34期94-100,共7页
Medical Innovation of China
基金
青海省医药卫生科技项目(2021-wjzdx-117)。
关键词
腹腔感染
分离菌株
耐药性
抗生素
Intra-abdominal infection
Isolated strain
Drug resistance
Antibiotic
