腹腔感染病原菌耐药性监测

Drug resistance surveillance of pathogens in intra-abdominal infection

目的监测2009年1月-2011年12月腹腔感染患者病原菌菌谱及耐药性,为临床治疗提供参考依据。方法采用VITEK-32微生物自动分析仪鉴定细菌,采用K-B法进行药敏试验。结果非重复临床分离的2501株病原菌中,需氧/兼性厌氧菌占96.76%;位于前3位的革兰阴性杆菌为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌,分别占25.31%、12.00%、10.95%;前3位革兰阳性菌为屎肠球菌、粪肠球菌及金黄色葡萄球菌,分别占10.43%、6.08%、4.76%;厌氧菌占1.12%,其中拟杆菌占首位;真菌占2.12%,以白色假丝酵母菌为主;大肠埃希菌和肺炎克雷伯菌产ESBLs检出率分别为52.61%和39.33%;各种肠杆菌科细菌对亚胺培南仍高度敏感,铜绿假单胞菌对碳青霉烯类药物耐药率已达>40.00%;屎肠球菌和粪肠球菌对高浓度庆大霉素耐药率分别为62.07%和44.74%;MRSA检出率为67.23%,未发现万古霉素耐药株。结论腹腔感染病原菌以大肠埃希菌为主,已出现泛耐药的大肠埃希菌和铜绿假单胞菌,对临床构成威胁。

OBJECTIVE To investigate the pathogenic bacteria spectrum and drug resistance characteristics in patients with intra-abdominal infection and provide the basis for clinical treatment. METHODS The isolated bacte- ria were identified by the automatic VITEK-32 analyzer system and the drug sensitivity test was performed using K-B methods. RESULTS Of the 2501 non-repetitive clinical isolates, aerobic, facultative and anaerobic bacteria accounted for 96. 76%. The first three gram-negative bacillus were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, which accounted for 25.31%, 12.00%, 10. 95%, respectively. The first three gram- positive bacteria were Enterococcus f aeciurn , Enterococcus f aecalis and Staphylococcus aureus , which accounted for 10.43%, 6. 08%, 4. 76%, respectively. The anaerobic bacteria accounted for 1. 12%, and the fungi was 2.12%, mainly of Candida albicans. 52.61% of E. coli and 39.33% of K. pneumoniae were ESBLs producers. Isolates of Enterobacteriaceae were still highly sensitive to imipenem. However, more than 40% of P. aeruginosa were resistant to the above carbapenems. The rates of E. faecium and E. faecalis which were resistant to high concentration gentamicin were 62.07% and 44.74%. The detection rates of MRSA were 67.23%. No vancomycin resestant isolates were found. CONCLUSION E. coli is the predominant organism in intra-abdominal infections. Pan-resistant E. coli and P. aeruginosa have appeared, which will result in a clinical threat.