急腹症患者合并感染性休克的病原菌分布及耐药性监测

Distribution and drug resistance of pathogenic bacteria casing acute abdomen complicated with septic shock

目的研究急腹症合并感染性休克患者感染病原菌的分布及耐药性,为临床诊治提供参考。方法选取医院2012年3月-2013年3月43例急腹症合并感染性休克患者资料进行分析,对患者疑似感染部位取分泌物及血液标本送检,依据《全国临床检验操作规程》进行常规分离培养和鉴定,根据NCCLS(2008年)标准进行药敏试验,对病原菌分布及耐药性进行分析。结果 43例患者共培养出57株病原菌,以血液标本为主,占38.60%,其次为腹水和痰液,均占22.81%;感染病原菌以革兰阴性菌为主,占85.96%,其次为革兰阳性菌与真菌,分别占10.53%、3.51%,排名前3位的病原菌分别是大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌,分别占36.84%、22.81%、8.77%;革兰阴性菌对氨苄西林、头孢噻肟、庆大霉素、氨苄西林/舒巴坦、头孢曲松耐药率>50.00%,特别是对氨苄西林,耐药率达100.00%,对亚胺培南高度敏感,金黄色葡萄球菌对万古霉素高度敏感。结论急腹症合并感染性休克患者感染灶分布广,血液、腹水、痰、尿、胆汁培养均存在病原菌感染,且病原菌耐药性较高。

OBJECTIVE To study the distribution and drug resistance of pathogenic bacteria causing acute abdomen complicated with septic shock so as to guide the clinical diagnosis and treatment. METHODS The clinical data of 43 patients complicated with acute abdomen and septic shock who were treated in the hospital from Mar 2012 to Mar 2013 were analyzed, then the secretions and blood specimens were sampled from the suspected infection sites, and the routine culture and identification were performed by referring to the National Clinical Laboratory Procedures; the drug susceptibility testing was carried out according to NCCLS （2008） ; the distribution and drug resistance of the pathogens were analyzed. RESULTS Totally 57 strains of pathogens were isolated from 43 patients; the blood was the predominant specimens source （38.60%）, followed by the ascite （22.81%） and sputum （22.81%）. The gram-negative bacteria were dominant among the pathogens causing infections, accounting for 85.96%, followed by the gram-positive bacteria （10.53%） and the fungi （3.51%）; the Escherichia coli, Klebsiella pneurnoniae, and Staphylococcus aureus ranked the top three species of pathogens, accounting for 36. 84%, 22.81%, and 8.77%, respectively. The drug resistance rates of the gram-negative bacteria to ampicillin, cefotaxime, gentamicin, ampicillin-sulbactam, and ceftriaxone were more than 50.00%, especially the drug resistance rate to ampicillin up to 100.00 %, showing high sensitivity to imipenem, and the Staphylococcus aureus strains were highly susceptible to vancomycin. CONCLUSION The acute abdomen merged with septic shock patients show a wide distribution of loci, the pathogenic bacteria may distribute in blood, ascites, sputum, urine, or bile and are highly drug resistant.