温州地区2010至2014年扁桃体周围脓肿病原菌分布及耐药性变迁

Distribution and drug resistance of bacterial pathogens isolated from peritonsillar abscess during ;2010-2014 in Wenzhou

目的：探讨扁桃体周围脓肿患者的病原菌分布及菌株对抗菌药物的耐药性变迁。方法连续收集2010年1月至2014年12月温州市中心医院扁桃体周围脓肿患者脓液的病原菌资料。菌株鉴定使用Vitek32鉴定系统，药敏试验采用K-B法。采用线性趋势χ2检验分析病原菌分布变化及对抗菌药物的耐药性变迁。结果5年共分离出病原菌2864株，其中革兰阴性杆菌1786株（62.4％），检出率呈上升趋势（χ^2＝84.74，P＜0.01），主要菌株为铜绿假单胞菌、鲍曼不动杆菌和流感嗜血杆菌，占72.5％（1295／1786），前两种菌株检出率呈上升趋势（χ^2＝83.75和24.74，P ＜0.01）；革兰阳性球菌1078株（37.6％），主要为金黄色葡萄球菌和溶血性链球菌，占83.2％（897／1078）。铜绿假单胞菌对头孢他啶、头孢哌酮、哌拉西林／他唑巴坦的耐药率呈上升趋势（χ^2＝16.17、13.48和11.44， P ＜0.05），而对庆大霉素、阿米卡星的耐药率呈下降趋势（χ^2＝16.54和16.63，P＜0.05）。鲍曼不动杆菌对头孢他啶、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦的耐药率呈上升趋势（χ^2＝12.52、10.85和14.14，P＜0.05）。流感嗜血杆菌对氨苄西林的耐药率呈上升趋势（χ^2＝10.21，P＜0.05），产β-内酰胺酶的流感嗜血杆菌5年检出率呈上升趋势（χ^2＝10.38，P＜0.05）。金黄色葡萄球菌对头孢唑啉和甲氧西林的耐药率呈上升趋势（χ^2＝15.44和12.53，P＜0.05），未发现有耐万古霉素菌株。溶血性链球菌对所有抗菌药物均保持敏感。结论温州市中心医院扁桃体周围脓肿以革兰阴性杆菌感染为主，其中铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌对常用抗菌药物的耐药形势严峻。

Objective To investigate the distribution and drug resistance of bacterial pathogens isolated from peritonsillar abscess .Methods Data on bacterial pathogens isolated from peritonsillar abscess in Wenzhou Central Hospital from January 2010 to December 2014 were retrospectively analyzed .Strains were identified with Vitek 32 identification system and the drug susceptibility test was performed with K-B method.Chi-square test for linear trend was performed to reveal the changes of distribution and drug resistance of the strains .Results A total of 2 864 bacterial strains were isolated in five years , in which 1 786 strains were Gram-negative bacilli （62.4%）, and 1 078 （37.6%） strains were Gram-positive cocci. The positive rate of Gram-negative bacilli was on the rise during year 2010-2014 （χ^2 =84.74, P〈0.01）, and the top three Gram-negative bacilli were Pseudomonas aeruginosa, Acinetobacter baumannii and Haemophilus influenzae, which accounted for 72.5%（1 295/1 786） of the total Gram-negative strains, and the positive rates of first two bacilli were on the rise （χ^2 =83.75 and 24.74, P〈0.01）.Gram-positive cocci were mainly Staphylococcus aureus and Hemolytic streptococcus, which accounted for 83.2% （ 897/1 078） of the total Gram-positive strains.Resistance rates of Pseudomonas aeruginosa to ceftazidime, cefoperazone, piperacillin/tazobactam were on the rise （χ^2 =16.17, 13.48 and 11.44, P〈0.05）, while resistance rates to gentamicin and amikacin were on the decline （χ^2 =16.54 and 16.63, P 〈0.05）. Resistance rates of Acinetobacter baumannii to ceftazidime, cefoperazone/sulbactam and piperacillin/tazobactam were on the rise （χ^2 =12.52, 10.85 and 14.14, P〈0.05）.Resistance rates of Haemophilus influenzae to ampicillin were on the rise （χ^2 =10.21, P〈0.05）, and the positive rate of β-lactamase producing strains was also on the rise （χ^2 =10.38, P〈0.05）.Resistance rates of Staphylococcus aureus to cefazolin and methicillin were on the rise （χ^2 =15.44 and 12.53, P〈0.05）, but no vancomycin resistant strain was found .Hemolytic streptococcus were sensitive to all commonly used antibiotics .Conclusions Peritonsillar abscess in Wenzhou Central Hospital is mainly induced by Gram-negative bacilli infection . Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus are the top three bacterial pathogens , and are highly resistant to most antibiotics .