【摘要】 目的分析腹腔感染病人腹腔引流液中病原菌布及其耐药性。方法收集2012年1月至2014年12月大连医科大学附属第一医院收治的310例腹腔感染病人的腹腔引流液标本,对其进行细菌鉴定及耐药分析,分析病原菌分布与细菌耐药性变化。结果腹腔引流液标本分离出病原菌578株,其中革兰阴性菌377株(65.2%),革兰阳性菌156株(27.0%),真菌45株(7.8%);3年总分离数量最高的前5位病原菌为大肠埃希菌(19.6%)、肺炎克雷伯菌(11.4%)、鲍曼不动杆菌(10.2%)、屎肠球菌(8.1%)、铜绿假单胞菌(7.3%);屎肠球菌对多数被测药物的耐药率高于粪肠球菌,对氨苄青霉素、环丙沙星、左氧氟沙星、红霉素耐药率均>80%,葡萄球菌对复方新诺明、氯霉素的敏感率>90.0%,3年均未发现耐万古霉素及利奈唑胺的革兰阳性菌;肠杆菌科细菌中产超广谱β内酰胺酶的检出率>55.0%,对碳青霉烯类药物、阿米卡星、β-内酰胺类联合酶抑制剂敏感率较高,对三代头孢菌素耐药严重,碳青霉烯类耐药的肠杆菌科细菌的检出率呈逐年上升趋势;鲍曼不动杆菌除对米诺环素(11.9%)、头孢哌酮/舒巴坦(37.3%)耐药率较低外,对其他测试药物耐药率均>60.0%,其中对碳青霉烯类药物耐药率>70.0%,对头孢曲松、头孢噻肟耐药率>80.0%,对庆大霉素耐药率>90.0%,而铜绿假单胞菌对碳青霉烯类药物、头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、阿米卡星的耐药率低于鲍曼不动杆菌。结论腹腔感染病人腹腔引流液病原菌以肠杆菌科为主,非发酵菌所占比例亦较高,部分细菌耐药率有逐年升高趋势,应严密监测以指导合理使用抗菌药物。更多还原

【Abstract】 ObjectiveTo investigate the distributions and antimicrobial resistances of the bacteria in abdominaldrainage fluid in intro-abdominal infection(IAI).MethodsThe abdominal drainage fluid specimen of 310 cases of IAIadmitted from January 2012 to December 2014 in the First Affiliated Hospital of Dalian Medical University wascollected. The bacterial distributions and antimicrobial resistances were analyzed.ResultsA total of 578 clinicalisolates were collected,of which gram-negative organiams, gram-positive cocci and fungi accounted for 65.2%(377strains),27.0%(156 strains)and 7.8%(45 strains)respectively. The top five most prevalent isolated pathogens wereescherichia coli(19.6%),klebsiella pneumonia(11.4%), acinetobacter baumannii(10.2%),enterococcus faecium(8.1%),pseudomonas aeruginosa(7.3%). The resistance rate of E. faecium to most antibiotics was higher than that of E.faecalis. The resistance rates of E.faecium and E. faecalis against to ampicillin, ciprofloxacin, levofloxacin anderythromycin were all above 80%,and the sensitive rates of sulfamethoxazole and chloromycetin against staphylococcuswere above 90%. No strain was found resistant to vancomycin or linezolid. The prevalence of ESBLs inenterobacteriaceae was above 55%, and the sensitive rates were higher in carbapenems, amikacin and β-Lactamaseinhibitors, but severely resistant to the third generation cephalosporin. The prevalence rate of carbapenem-resistantenterobacteriaceae(CRE) was increasing yearby year. The resistance rates of minocyclineand cefperrazone-sulbactam againstacinetobacter baumannii were 11.9% and37.3%,which of other antimicrobial drugs were above 60%,of carbapenem was above 70%,of ceftriaxone and cefotaximeabove 80%, of gentamicin above 90%. The sensitive rates of carbapenem,ceftazidime,cefepime,piperacillin sodium andtazobactam sodium,amikacin against pseudomonas aeruginosa were higher than those against acinetobacter baumannii.ConclusionThe enterobacteriaceae and non-fermentative bacterias are the chief bacteria in IAI. Multi-drug resistantbacteria is serious,and the resistance rate is increasing year by year. Extensive and dynamical monitoring of pathogensresistance should be performed and rational use of antibiotics are advocated.更多还原