685例重症急性胰腺炎患者中血流感染病原菌谱及抗菌药物敏感性分析

Analysis of Pathogenic Bacteria Spectrum and Antimicrobial Susceptibility in 685 Patients with Severe Acute Pancreatitis

目的分析重症急性胰腺炎患者中血流感染病原菌谱及抗菌药物敏感性情况,探讨其血流感染来源及抢先治疗的最佳抗菌方案。方法回顾性分析四川大学华西医院2014年至2017年685例重症急性胰腺炎患者血培养结果,按照美国临床和实验室标准化协会(CLSI) M39-A4标准判读报告药敏,同时统计分析血培养阳性患者其他标本检出菌。结果 29. 1%(199/685)患者血培养阳性,62. 8%(125/199)患者检出革兰阴性菌,25. 6%(51/199)患者检出革兰阳性菌,13. 0%(26/199)患者检出真菌,8. 0%(16/199)患者为复数菌感染,前3位检出菌分别是肺炎克雷伯菌(44株),大肠埃希菌(29株),鲍曼/醋酸钙不动杆菌复合体(27株)。199例患者其他标本检出菌302株,所有标本检出菌517株,多重耐药菌检出比例为38. 1%(197/517)。血培养检出的所有革兰阴性菌对亚胺培南的敏感率是59. 4%,联合左氧氟沙星敏感率增至70. 7%,亚胺培南联合头孢吡肟、哌拉西林/他唑巴坦敏感率分别为67. 9%、64. 1%;哌拉西林/他唑巴坦联合左氧氟沙星、头孢吡肟敏感率分别为56. 6%、55. 6%。结论重症急性胰腺炎患者中血流感染病原菌以革兰阴性菌为主,感染源主要来自腹腔,体外药敏数据显示,亚胺培南联合左氧氟沙星优于其他抢先治疗联合方案,可覆盖70. 7%的革兰阴性菌。革兰阳性菌、真菌引起的血流感染也不容忽视。

Objective To analyze the pathogenic bacteria spectrum and antimicrobial sensitivity of blood stream infection in patients with severe acute pancreatitis,to explore the origin of blood stream infection and the best antimicrobial regimen for pre-emptive treatment.Methods The results of the blood culture of 685 patients with severe acute pancreatitis from 2014 to 2017 in West China Hospital of Sichuan University were analyzed retrospectively. According to the M39-A4 standard of the American clinical and laboratory standardization association（ CLSI）,the drug sensitivity was reported and the other specimens of the positive patients with blood culture were detected.Results 29. 1%（ 199/685） patients were positive for blood culture,Gram-negative bacteria were detected in 62. 8%（ 125/199） patients,Gram-positive bacteria were detected in 25. 6%（ 51/199） patients,fungi were detected in 13%（ 26/199） patients,8%（ 16/199） patients were complex bacteria infection.The top three strains were Klebsiella pneumoniae（ 44 strains）,Escherichia coli（ 29 strains）,and Acinetobacter baumannii/Acinetobacter acetate complex（ 27 strains）. 302 strains of bacteria were detected in other specimens of 199 patients,517 strains were detected in all specimens,and the detection rate of multi-drug resistant bacteria was 38. 1%（ 197/517）.The sensitivity of all Gram-negative bacteria detected in blood culture to imipenem was 59. 4%,the sensitivity of combined levofloxacin increased to 70. 7%,and the sensitivity rate of imipenem combined with cefepime,piperacillin/tazobactam was 67. 9% and 64. 1%,respectively,and the sensitivity rate of piperacillin/tazobactam combined with levofloxacin and cefepime was 56. 6% and 55. 6%,respectively. Conclusions Gram-negative bacteria were the main pathogens of blood flow infection in patients with severe acute pancreatitis,and the main source of infection came from abdominal cavity.In vitro susceptibility data showed that imipenem combined with levofloxacin was superior to other pre-emptive treatment regimens,covering 70. 7% of gram-negative bacteria. Blood infection caused by Gram-positive bacteria and fungi could not be ignored.