重症急性胰腺炎术后胰腺感染病原菌及药物敏感性分析

Bacterial infection in postoperative severe acute pancreatitis

目的分析因重症急性胰腺炎行引流手术且术后合并胰腺感染患者的细菌学及药敏报告,为重症急性胰腺炎术后感染的抗生素应用提供临床参考。方法收集2003年1月—2006年4月间86例重症急性胰腺炎术后患者腹腔引流物标本,对标本进行细菌培养,检测菌株对抗生素的耐药情况。结果 86例患者中共分离出276株细菌,检出率分别为阴沟肠杆菌(12.3%)、铜绿假单胞菌(10.9%)、金黄色葡萄球菌(9.4%)、其他葡萄球菌(9.4%)、D 群链球菌(9.4%)、粪肠球菌(8.7%)、大肠埃希菌(8.7%)、表皮葡萄球菌(6.5%)、肺炎克雷伯菌(4.3%)、屎肠球菌(4.3%)。药敏分析及耐药试验表明重症急性胰腺炎术后胰腺感染耐药严重,对于革兰阳性球菌,万古霉素和替考拉宁尚保持了较好的抗菌活性,对于革兰阴性杆菌仅碳青酶烯类抗生素对其存在较好的抗菌活性。结论对重症急性胰腺炎术后胰腺感染患者,大部分菌株广泛耐药,临床上应依据细菌药物敏感性结果,不断调整抗生素。

Objective To retrospectively analyze antibiotic sensitivities of the causative organisms in patients receiving drainage and complicating pancreatic infection in our pancreatic center and to provide a clinical reference to prophylactic and therapeutic antibiotics in cases after operation for severe acute pancreatitis. Methods Peritoneal drainage samples from 86 infected postoperative patients from January 2003 to April 2006 were collected and cultured for bacteria. The patterns of sensitivity of the infecting organisms were tested with classical method. Results A total of 276 bacterial strains were found, including Enterobacter cloacae （ 12. 3% ）, Pseudomonas aeruginosa （ 10. 9% ）, Staphylococcus aureus （9.4%）, other Staphylococci （9. 4% ）, Streptococcus group D （9.4%）, Enterococcus faecalis （8.7%）, Bacillus coli （ 8.7% ）, Staphylococcus epidermidis （ 6.5% ）, Klebsiella pneumoniae （ 4. 3% ）. Our data demonstrated that most bacterias were resistant to many common antibiotics. For Gram positive coccus, vancomycin and teicoplanin retain antibacterial activity. For Gram negative bacilli, only imipenem was of antibacterial activity. Conclusion In cases of severe acute pancreatitis most bacteria are resistant to common antibiotics . It is critical to perform the sensitivity test of bacteria.