胃肠外科住院患者术后感染病原菌分布及耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria causing postoperative infections in gastrointestinal surgical inpatients

目的 调查2011~2015年胃肠外科患者术后感染病原菌的分布及耐药情况,为临床合理应用抗菌药物提供依据。方法 采用BacT/ALERT3D全自动培养仪、VITEK-2系统进行菌种鉴定和药物敏感试验,运用WHONET5.6软件统计分析。结果 1 140份标本检出病原菌753株,标本来源主要以血液、痰液、腹腔引流液、脓液及尿液为主（77.7%）;病原菌中革兰阴性菌537株（71.3%）,革兰阳性菌198株（26.3%）,真菌18株（2.4%）;位于前5位的检出病原菌为大肠埃希菌（32.3%）、肺炎克雷伯菌（11.4%）、铜绿假单胞菌（10.0%）、金黄色葡萄球菌（8.1%）及鲍曼不动杆菌（5.8%）。大肠埃希菌、肺炎克雷伯菌及铜绿假单胞菌对头孢二、三代抗菌药均有较高的耐药性,但对哌拉西林/他唑巴坦及亚胺培南耐药率低。鲍曼不动杆菌对多种抗菌药物耐药性均较高（〉50%）,未发现耐万古霉素的阳性葡萄球菌株,革兰阳性菌金黄色葡萄球菌对喹诺酮类抗菌药物耐药性较高（〉40%）,但葡萄球菌、肠球菌对传统抗生素青霉素和红霉素具有较高的耐药性（均〉50%）,粪肠球菌、屎肠球菌对万古霉素、利奈唑胺高度敏感。结论 加强细菌耐药性监测,减少耐药菌的发生及传播对提高胃肠外科感染治疗效果具有重要意义。

Objective To explore the distribution and drug resistance of pathogenic bacteria causing postoperative infections in gastrointestinal surgical inpatients during 2011-2015 in order provide the basis for clinical rational use of antibacterial drugs .Meth‐ods The bacterial species identification and drug susceptibility test were performed by adopting the BacT/ALERT3D automatic culture system and VITEK‐2 system .The analysis was performed by using the WHONET5 .6 statistical software .Results Among 1 140 specimens ,753 strains of pathogenic bacteria were detected .The specimens sources were mainly blood ,sputum ,abdominal drainage fluid ,pus and urine （77 .7% ） .In pathogenic bacteria ,537 strains （71 .3% ） were Gram‐negative bacteria（G-） ,198 strains （26 .3% ） were Gram positive bacteria（G＋ ） and 18 strains （2 .4% ） were fungi .The top five detected pathogenic bacteria were E . coli （32 .3% ） ,klebsiella pneumoniae （11 .4% ） ,pseudomonas aeruginosa （10 .0% ） ,staphylococcus aureus （8 .1% ） and acinetobact‐er baumannii （5 .8% ） .E .coli ,klebsiella pneumoniae and pseudomonas aeruginosa had higher resistance to second and third genera‐tion cephalosporin antibacterials ,but had lower resistance to piperacillin/tazobactam and imipenen ,acinetobacter baumannii had higher resistance to multiple antimicrobial agents （〉 50% ） ,no vancomycin‐resistant positive staphylococcus strain was found;Gram‐positive staphylococcus aureus had higher resistance to quinolones （〉40% ） and traditional antibiotics of penicillin and eryth‐romycin（〉50% ）;enterococcus faecalis and enterococcus faecium were highly sensitive to vancomycin and linezolid .Conclusion Strengthening the bacterial drug resistance surveillance and reducing the generation and spread of drug‐resistant bacteria is of great significance to improve the effect of gastrointestinal surgical infection treatment .