2型糖尿病合并肛周脓肿患者病原菌分布及耐药性分析

Distribution and drug resistance of pathogens in patients with type 2 diabetes mellitus complicated with perianal abscess

目的分析2型糖尿病(type 2 diabetes mellitus,T2DM)合并肛周脓肿患者脓液培养病原菌分布及耐药性。方法回顾性分析本院收治的肛周脓肿脓液细菌培养呈阳性的40例T2DM患者(T2DM组)病原菌分布以及耐药率,以40例无T2DM肛周脓肿患者为对照(对照组),比较2组患者脓肿培养主要病原菌分布情况以及对临床常用抗生素的耐药率。结果2组培养出的病原菌为大肠埃希菌、肺炎克雷伯菌,T2DM组大肠埃希菌检出率(67.50%)低于对照组(87.50%),肺炎克雷伯菌检出率(32.50%)高于对照组(12.50%),差异均有统计学意义(P均<0.05)。T2DM组产超广谱β-内酰胺酶大肠埃希菌检出率,大肠埃希菌对氨苄西林、复方磺胺甲恶唑、头孢曲松、左氧氟沙星耐药率均明显高于对照组(P均<0.05)。结论T2DM合并肛周脓肿患者的病原菌分布与无T2DM肛周脓肿患者具有明显差异,在T2DM合并肛周脓肿患者的临床治疗中,如果病原菌为大肠埃希菌,应尽量避免使用复方磺胺甲恶唑、头孢曲松、左氧氟沙星等抗生素,尽量选用含酶抑制剂复合制剂、亚胺培南等耐药性较低的抗菌药物。

Objective To analyze the distribution and drug resistance of pathogenic bacteria in abscess culture of type 2 diabetes mellitus(T2DM)patients with perianal abscess.Methods The distribution and drug resistance of pathogens in 40 T2DM patients with perianal abscess(T2DM group)who were positive for bacterial culture were retrospectively analyzed.Another 40 non-T2DM patients were taken as control group.The distribution of main pathogens in abscess culture and drug resistance of clinically common antibiotics in 2 groups were compared.Results Escherichia coli and Klebsiella pneumoniae were cultured in the 2 groups.The detection rate of Escherichia coli in the T2DM group(67.50%)was lower than that in the control group(87.50%).The detection rate of Klebsiella pneumoniae in the T2DM group(32.50%)was higher than that in the control group(12.50%).The difference was statistically significant between 2 groups(P<0.05).The detection rate of extended-spectrum beta-lactamase-producing Escherichia coli,and the drug resistance rate of Escherichia coli to ampicillin,compound trimethoprim,ceftriaxone and levofloxacin in T2DM group were significantly higher than those in control group(P<0.05).Conclusion The distribution of pathogenic bacteria in T2DM patients complicated with perianal abscess is significantly different from that in non-T2DM patients.In the clinical treatment of T2DM patients complicated with perianal abscess,if the pathogenic bacteria are Escherichia coli,the antibiotics such as compound trimethoprim,ceftriaxone and levofloxacin should be avoided.The antibiotics with lower resistance such as enzyme inhibitor compound preparation and imipenem should be chosen.