胰十二指肠切除术后腹腔感染病原菌及耐药性分析

Pathogens and antibiotic resistance of abdominal infection after pancreaticoduodenectomy

目的了解胰十二指肠切除术(pancreaticoduodenectomy,PD)后腹腔感染的主要病原菌分布及药物敏感性特点,及抗菌药物使用情况,为临床防治提供依据。方法对我院2014年9月至2016年3月行PD术的221份病例进行回顾性调查,对其中54例发生术后腹腔感染的病例进行分析,调查细菌培养结果及耐药情况,分析抗菌药物使用情况。结果 54例患者术后发生腹腔感染,感染发生率为24.4%。共获得腹液标本94份,检出细菌138株,包括革兰阴性菌87株(占63.04%),革兰阳性菌51株(占36.96%),前5位病原菌依次为粪肠球菌、大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌和屎肠球菌。54例腹腔感染者中多种菌混合感染为33例(占61.11%)。产超广谱β-内酰胺酶(ESBLs)菌在大肠埃希菌和肺炎克雷伯菌中分别为88.24%和46.67%;耐甲氧西林葡萄球菌(MRS)在表皮葡萄球菌和溶血葡萄球菌中均为80%。肺炎克雷伯杆菌、大肠埃希菌和阴沟肠杆菌均对第二、三代头孢菌素耐药率较高,对阿米卡星、亚胺培南敏感性最高。屎肠球菌和溶血性葡萄球菌仅对利奈唑胺和万古霉素的敏感率较高。结论 PD术后腹腔感染的病原菌以革兰阴性菌为主,大多数细菌具有多重耐药性。

Objective To investigate the main pathogenic bacteria distribution and sensitivity to antibiotics for abdominal infection after pancreaticoduodenectomy （ PD） and the utilization of antibiotics, providing evidences for clinical treatment. Methods The clinical data of 221 cases of PD from September 2014 to March 2016 were collected and analyzed retrospectively. Results Abdominal infection occurred in 54 patients after PD and the incidence of infection was 24.4%. Total 94 samples of abdominal fluid were collected and 138 strains of bacteria were detected. Among them there were 87 strains of Gram negative bacteria, accounting for 63.04%, and 51 strains of Gram positive bacteria, accounting for 36.96%. The top 5 pathogens were Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Enterobacter and Enterococcus faecium. Mixed bacterial infection was 33 cases （ 61.11%） . ESBLs-producing strains accounted for 88.24% and 46.67% in Escherichia coli and Klebsiella pneumoniae, respectively. The detection rates of MRS were both 80% in Staphylococcus aureus and Staphylococcus aureus. The lowest resistance of Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae lied in amikacin and imipenem. Enterococcus Faecium and Staphylococcus haemolyticus were only sensitive to linezolid and vancomycin. Conclusion The predominant pathogenic bacteria of intra-abdominal infection after PD are Gram negative bacilli, in which most bacteria have multiple resistances.