肝胆外科住院患者病原菌构成及耐药性分析

Analysis of pathogen composition and drug resistance of patients with Hepatobiliary surgery

目的了解肝胆外科病房感染患者病原菌构成及其药敏谱,为临床抗感染治疗提供实验依据。方法回顾性总结分析2015年1月-2017年6月肝胆外科感染患者各类感染性标本分离的病原菌,采用BD-phoenix100TM全自动细菌鉴定/药敏分析系统及配套试剂对病原菌进行鉴定和药物敏感性试验。结果肝胆外科送检的感染性标本主要见于血液、胆汁、穿刺液和引流液等,病原菌构成以革兰阴性杆菌为主,占70.6%,主要为大肠埃希菌和肺炎克雷伯菌,革兰阳性球菌占25.6%,主要为肠球菌,真菌占3.8%。药敏结果显示,碳青霉烯类(亚胺培南、美罗培南)、加酶抑制剂类(头孢哌酮/舒巴坦、哌拉西林/他唑巴坦)以及阿米卡星等抗菌药物对肠杆菌科细菌具有较高的敏感性,大肠埃希菌和肺炎克雷伯菌ESBL的检出率分别为30.8%和36.2%,革兰阳性球菌中未发现耐万古霉素的肠球菌和葡萄球菌。结论肝胆外科患者送检的感染性标本病原菌的检出率较高,病原菌种类较多,主要以革兰阴性杆菌为主,临床应重视病原学的检测。

Objective To understand the composition of pathogenic bacteria in patients with Hepatobiliary surgical ward and its drug sensitization spectrum,and provide experimental basis for clinical anti-infection treatment.MethodsA retrospective analysis of patients with various types of infectious pathogenic bacteria isolated from January 2015 to June 2017 in Department of Hepatobiliary surgery infection,using BD-phoenix100 TM automatic bacteria identification/susceptibility analysis system and reagents for identification and drug sensitivity test of pathogenic bacteria.ResultsNosocomial infection from Department of hepatobiliary surgery mainly in blood,bile,puncture and drainage fluid;pathogens of gram negative bacilli,accounting for 70.6%,mainly Escherichia coli and Klebsiella pneumoniae,gram positive cocci accounted for 25.6%,mainly for Enterococcus,fungi accounted for 3.8%.According to the results of drug susceptibility,carbapenems（imipenem and meropenem）and enzyme inhibitors（Cefoperazone/sulbactam,piperacillin/tazobactam）and amikacin antibacterial drugs had higher sensitivity to Enterobacteriaceae,Escherichia coli and Klebsiella pneumoniae.The detection rate of ESBL respectively.30.8% and 36.2%;No vancomycin-resistant enterococcus and staphylococcus were found in gram-positive cocci.Conclusion The detection rate of infectious specimens of patients with hepatobiliary surgery was higher,and there were more kinds of pathogens,mainly gram-negative bacilli,and clinical attention should be paid to the detection of etiology.