【摘要】 目的探讨肝胆胰外科患者血流感染病原菌的分布及耐药性,为临床治疗和感染防控提供依据。方法回顾分析2012年1月—2016年12月肝胆胰外科患者血培养阳性分离株的分布及药敏结果,采用Whonet 5.6进行耐药性统计。结果 1850例患者4255套血培养标本共分离出457株病原菌。其中革兰阴性需氧菌287株(62.8%),革兰阳性需氧菌140株(30.6%),真菌24株(5.3%),厌氧菌6株(1.3%)。大肠埃希菌对亚胺培南、美罗培南及替加环素耐药率均为0%;肺炎克雷白杆菌对替加环素、阿米卡星和亚胺培南的耐药率分别为6.5%,6.5%和8.1%;鲍曼不动杆菌对替加环素、米诺环素和头孢哌酮/舒巴坦的耐药率分别为8.3%,22.2%和38.9%;革兰阳性菌中未发现对利奈唑胺、万古霉素、替考拉宁和替加环素耐药的菌株,耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的发生率分别达到92.5%和91.7%。结论该院肝胆胰外科患者血流感染的多重耐药菌比例较高,需联合治疗以及加强耐药性监测和感染防控措施。更多还原

【Abstract】 Objective To investigate the distribution and drug resistance of pathogens in patients with bloodstream infection from hepatobiliary and pancreatic surgery, and to provide evidence for clinical treatment and infection control. Methods The distribution and drug sensitivity results of positive blood cultures in patients in hepatobiliary and pancreatic surgery from January 2012 to December 2016 were retrospectively analyzed. Whonet 5.6 was used for the statistics of drug resistance. Results Totally, 457 strains were isolated from 4255 of blood cultures of 1850 patients. Aerobic gram negative bacteria were 287 strains(62.8%), aerobic gram positive bacteria were 140 strains(30.6%), fungi were 24 strains(5.3%), and anaerobic bacteria were 6 strains(1.3%). The resistance rate of imipenem, meropenem and tigecycline to Escherichia coli was 0%. The resistance rate of tigecycline, imipenem and amikacin to Klebsiella pneumoniae was 6.5%, 6.5% and 8.1%, respectively. The resistance rate of tigecycline, minocycline and cefoperazone sulbactam to Acinetobacter baumanii was 8.3%, 22.2% and 38.9%, respectively. Gram positive bacteria that are resistant to linezolid, vancomycin, teicoplanin or tigecycline were not found. The incidence rate of MRSA and MRCNS was 92.5% and 91.7%, respectively. Conclusion The proportion of multiple drug resistant bacteria in patients with bloodstream infection from hepatobiliary and pancreatic surgery is high. The combined treatment is needed, and the drug resistance monitoring and infection control measures should be strengthened.更多还原