细菌性肝脓肿患者的病原菌分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria in patients with bacterial liver abscess

目的探讨细菌性肝脓肿患者的病原菌分布及耐药性检测,指导临床用药。方法收集97例细菌性肝脓肿患者的分泌物或引流液进行细菌培养,采用VITEK 2 Compact全自动微生物鉴定仪鉴定病原菌,采用纸片扩散法进行药敏试验。结果 97例细菌性肝脓肿标本中,共培养到54株细菌,其中革兰阴性菌45株,占83.3%(45/54),革兰阳性球菌9株,占16.7%(9/54)。革兰阴性菌中大肠埃希菌占24.4%(11/45),肺炎克雷伯菌占55.6%(25/45),铜绿假单胞菌、鲍氏不动杆菌各占4.4%(2/45),摩氏摩根菌、弗劳地枸椽酸杆菌、嗜水气单胞菌、产碱杆菌、黄杆菌各占2.2%(1/45)。革兰阳性菌中粪肠球菌、金黄色葡萄球菌各占33.3%(3/9),屎肠球菌占22.2%(2/9),表皮葡萄球菌占11.1(1/9)。结论细菌性肝脓肿患者感染的病原菌以革兰阴性杆菌为主,主要为肺炎克雷伯菌、大肠埃希菌,病原菌对亚胺培南、美罗培南等碳青霉烯类以及阿米卡星等抗菌药物敏感性高,应及时进行病原菌检测,指导临床治疗。

Objective To study the distribution and drug resistance of pathogenic bacteria in patients with bacterial liver abscess,so as to guide clinical drug use. Methods Secretion or drainage fluid from 97 patients with bacterial liver abscess were collected for bacterial culture,the automatic microbial identification instrument VITEK 2 Compact was used for the identification of pathogenic bacteria,and drug sensitivity test was carried out by paper diffusion. Results 54 strains of pathogenic bacteria were detected from 97 cases of bacterial liver abscess specimens,among which 45 strains were gram negative bacilli accounting for 83. 3%（ 45 /54）,9 strains were gram positive bacilli accounting for 16. 7%（ 9 /54）. Among the gram negative bacteria,Escherichia coli accounted for 24. 4%（ 11 /45）,Klebsiella pneumonia accounted for 55. 6%（ 25 /45）,Pseudomonas aeruginosa accounted for 4. 4%（ 2 /45）,Baumannii acinetobacter accounted for 4. 4%（ 2 /45）,and Morgan bacteria,Citrobacter,Aeromonas hydrophila,Alcaligenes sp.,Flavobacterium respectively accounted for 2. 2%（ 1 /45）. Among the gram positive bacilli,Enterococus faecalis and Staphylococcus aureus respectively accounted for 33. 3%（ 3 /9）. Enterococcus faecium accounted for22. 2%（ 2 /9） and Staphylococcus aureus accounted for 11. 1%（ 1 /9）. Conclusion Pathogen of infection in patients with bacterial liver abscess is gram negative bacilli,mainly including Klebsiella pneumonia,Escherichia coli. Pathogenic bacteria to imipenem,meropenem and amikacin for carbapenem antibiotics has high sensitivity,so detection of pathogens should be timely conducted to guide clinical treatment.