重症胰腺炎患者感染病原菌耐药及相关因素分析

An analysis of the pathogens infecting patients with severe pancreatitis,the drug resistance,of those pathogens,and other related factors

目的了解胰腺炎患者感染病原菌的分布、耐药情况以及相关感染因素,为胰腺炎感染的预防和治疗提供依据。方法选取2012年1月-2014年12月到本院就诊的208例重症胰腺炎患者作为研究对象。采用CT引导经皮下穿刺置管引流,取腹腔脓液进行培养并置无菌试管内送检、保存。菌株分离后培养并经全自动微生物鉴定仪进行鉴定进行药敏试验。结果 208例SAP就诊患者有61例患者发生胰腺感染,61例感染患者中共分离出102株病原菌,其中革兰阴性菌67株(占65.69%),革兰阳性菌35株(占34.31%)。革兰阴性菌中阴沟肠杆菌26株,产气肠杆菌15株,铜绿假单胞菌12株;金黄色葡萄球菌(15株)和表皮葡萄球菌(12株)为主要革兰阳性菌。肺炎克雷伯菌和铜绿假单胞菌对青霉素耐药程度超过70%。铜绿假单胞菌,大肠埃希菌和肺炎克雷伯菌均产生碳青霉烯类耐药菌。金黄色葡萄球菌对头孢呋辛、青霉素、诺氟沙星、哌拉西林和复方新诺明耐药程度较高均超过60%。对性别等8个因素进行分析显示,胰腺感染与性别、年龄和血压高低无相关性,与糖尿病、低氧血症、胃肠功能障碍时间、机械通气时间和肠外营养时间有相关性。讨论分离病原菌对青霉素、哌拉西林、诺氟沙星和头孢呋辛耐药程度较高;青霉素和氨基糖苷类抗生素不能作为胰腺感染的药物。胃肠功能障碍时间、机械通气时间和肠外营养时间是胰腺感染的危险因素,早期实施肠道营养,有利于改善肠黏膜循环状态和促进胃蠕动,减轻肠道菌群紊乱状态。

Objective To ascertain which pathogens are infecting patients with pancreatitis, the drug resistance of those pathogens, and other related factors in order to provide evidence for prevention and treatment of pancreatitis. Methods Subjects were 208 patients with severe acute pancreatitis seen at this Hospital from January 2012 to December 2014. CT- guided percutaneous catheter drainage of intra-abdominal abscesses was performed. Pus was collected. The pus was col- lected in a sterile test tube and it was sent for culturing, testing, and storage. Strains were isolated and cultured and iden- tified with an automated microbial identification system. Drug sensitivity testing was performed in accordance with the 2014 guidelines of the Clinical and Laboratory Standards Institute （CLSI）. Result A total of 102 strains of pathogenic bacteria were isolated, including 67 strains of Gram-negative bacteria （65.69%） and 35 strains of Gram-positive bacteria （34.31%）. The strains of Gram-negative bacteria included 26 strains of Enterobacter cloacae （25.49 %） , 15 of E. aero- genes, and 12 of Pseudomonasaeruginosa. Staphylococcus aureus and Staphylococcus epidermidis were the predominant Gram-positive bacteria. The Gram-negative bacteria Klebsiella pneumoniae and P. aeruginosa had resistance to penicillin of more than 70G and resistance to cefuroxime, penicillin, norfloxacin, piperaeillin, and cotrimoxazole of more than 60%. The only Gram-positive bacterium that was resistant to earbapenem was S. aureus. Pathogenic bacteria in this study had a low level of resistance to amikacin, gatifloxacin, meropenem, and imipenem. Eight factors for development of pancreatitis were analyzed. Results indicated that pancreatitis did not correlate with sex, age, or hypertension. Pancreati- tis did correlate with diabetes, hypoxia, the duration of gastrointestinal dysfunction, the duration of mechanical ventila tion, and the duration of parenteral nutrition. Conclusion The pathogenic bacteria isolated in this study were highly re-sistant to penicillin, piperacillin, norfloxacin, and cefuroxime. Penicillin and aminoglycosides have difficulty passing through the ＂blood-pancreas barrier,＂ so they cannot be used to treat pancreatitis. Reduced insulin secretion in patients with diabetes provided bacteria a glucose-rich environment in which to grow. The duration of gastrointestinal dysfunction, the duration of mechanical ventilation, and the duration of parenteral nutrition were risk factors for development of pan- creatitis. Early implementation of enteral nutrition can help to improve the circulation in the intestinal mucosa and pro- mote gastric peristalsis, reducing disruption of the intestinal flora.