系统性红斑狼疮患者革兰阴性菌感染病原菌分布及耐药性分析

Distribution of Pathogens and Their Antibiotic Resistance in Systemic Lupus Erythematosus Patients with Gram-negative Bacterial Infections

目的了解系统性红斑狼疮（SLE）患者革兰阴性菌感染病原菌的种类、分布及耐药性，为临床合理使用抗菌药物提供依据。方法应用ATB Expression自动细菌鉴定系统对菌种进行鉴定，用K-B纸片扩散法对病原菌进行药物敏感性试验。结果346例SLE患者并发病原菌感染112例，感染率为32．4％，例次感染率52．3％，共分离出病原菌181株，主要为大肠埃希菌（ECO）、铜绿假单胞菌（PAE）、肺炎克雷伯菌（KPN）、鲍氏不动杆菌（ABA）、奇异变形菌（PMI）、阴沟肠杆菌（ECL）；大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶（ESBLs）株检出率分别为27．5％和28．1％；药敏结果显示，哌拉西林／他唑巴坦和头孢吡肟对鲍氏不动杆菌抗菌作用差，对其他革兰阴性杆菌耐药率较低，分别为0～46．2％和13．0％～33．3％；美罗培南、亚胺培南及头孢哌酮／舒巴坦对革兰阴性杆菌的抗菌活性最强，耐药率分别为0～17．1％、0～22．9％和0～38．5％。结论SLE患者并发病原菌感染的临床表现无特异性，本组资料对SLE病原菌感染的治疗和抗菌药物的选用具有重要参考价值。

OBJECTIVE To study the distribution of pathogens and their antibiotic resistance in systemic lupus erythematosus （SLE） patients with gram--negative bacterial infections, for guiding the rational use of antibiotics therapy. METHODS The identification was analyzed by ATB Expression automatic microbiology analytical instrument system. The bacterial susceptibility test was done by Kirby-Bauer agar diffusion method. RESULTS Among 346 patients included, 112 （32.4%） had bacterial infections. A total of 181 pathogens strains had been isolated. Among 181 isolates, Escherichia coli , Pseudornonas aeruginosa , Klebsiella pneumoniae , Acinetobacter baumannii, Proteus mirabilis, and Enterobacter cloacae were the main pathogens. The ESBLs producing rates in E. coli and K. pneumoniae were 27. 5% and 28. 1%. Piperacillin/tazobactam and cefepime had less activity against A. baumannii and low resistant to other Gram-negative bacilli （0- 46. 2% and 13. 0- 33. 3%）. Meropenem, imipenem and cefoperazone/sulbactam showed greater activity against Gram-negative bacilli, their resistant rates were 0--17.1%,0-- 22.9% and 0--38.5%, respectively. CONCLUSIONS The clinical features of SLE patients with bacterial infections are lack of specificity. The data will be useful for reasonably choosing antimicrobial agents in the treatment of SLE patients with bacterial infections.