胃肠手术患者感染多药耐药革兰阴性菌分布与药敏分析

Distribution and drug susceptibility of multidrug-resistant gram-negative bacteria causing postoperative infections in patients undergoing gastrointestinal surgery

目的分析胃肠手术患者多药耐药(MDR)革兰阴性菌的分布及耐药性,为合理使用抗菌药物提供依据。方法 2012年1月-2014年4月对89例胃肠术后感染患者进行细菌培养及药敏试验,并采用重复序列PCR(REP-PCR)检测菌株同源性。结果共分离出63株革兰阴性菌,其中MDR 34株;鲍氏不动杆菌11株占32.36%、铜绿假单胞菌9株占26.47%、大肠埃希菌8株占23.53%;REP-PCR检测鲍氏不动杆菌有4个基因型,其中C型7株;铜绿假单胞菌有6个基因型,其中C型3株;大肠埃希菌有6个基因型,其中B型3株;鲍氏不动杆菌对青霉素类、氨基糖苷类、喹诺酮类及头孢菌素类抗菌药物耐药率高达100.00%;大肠埃希菌对亚胺培南、美罗培南敏感率达100.00%;铜绿假单胞菌对头孢菌素类抗菌药物的耐药率较高,对美罗培南的敏感率为100.00%。结论胃肠手术后MDR革兰阴性感染率较高,多数MDR革兰阴性菌对碳青霉烯类药物仍保持良好敏感性,但鲍氏不动杆菌呈泛耐药性,临床应加强重视。

OBJECTIVE To analyze the distribution and drug resistance of multidrug‐resistant gram‐negative bacte‐ria isolated from the patients undergoing gastrointestinal surgery so as to provide guidance for reasonable clinical use of antibiotics .METHODS The bacterial culture and drug susceptibility testing were performed for 89 patients with postoperative infections who underwent the gastrointestinal surgery from Jan 2012 to Apr 2014 ,and the ho‐mology of the strains was tested by using repetitive PCR （REP‐PCR） .RESULTS A total of 63 strains of gram‐neg‐ative bacteria have been isolated ,of which 34 were multidrug‐resistant strains ,including 11 （ 32 .36% ） strains of A cinetobacter baumannii ,9 （26 .47% ） strains of Pseudomonas aeruginosa ,and 8 （23 .53% ） strains of Escherich‐ia coli .Through the REP‐PCR test ,totally 4 genotypes were detected in the A .baumannii strains ,including 7 strains of genotype C ;6 genotypes were detected in the P .aeruginosa strains ,including 3 strains of genotype C ;6 genotypes were detected in the E .coli strains ,including 3 strains of genotype B .The drug resistance rates of the A .baumannii strains to penicillins ,aminoglycosides ,quinolones ,and cephalosporins were as high as 100 .00% ;the drug susceptibility rates of the E .coli strains to imipenem and meropenem were as high as 100 .00% ;the drug resistance rate of the P .aeruginosa strains to cephalosporins was high ,and the drug susceptibility rate to mero‐penem was 100 .00% .CONCLUSION The incidence of postoperative infections caused by the multidrug‐resistant gram‐negative bacteria is high in the patients undergoing the gastrointestinal surgery ,most of the multidrug‐resist‐ant gram‐negative bacteria strains remain highly susceptible to carbapenems ,and the A .baumannii strains are pan‐drug‐resistant ,to which the hospital should pay high attention .