合并糖尿病的肛周脓肿患者临床特征及病原菌分析

Clinical characteristics and pathogenic bacteria analysis of perianal abscess patients with diabetes mellitus

目的分析肛周脓肿患者临床特征、病原菌及其耐药性。方法比较糖尿病与非糖尿病组脓肿培养阳性率、病原菌种类及其耐药性等方面的差异。结果脓液培养总阳性率为69.3%;大肠埃希菌(Escherichiacoli,E.coli)和肺炎克雷伯菌(Klebsiella pneumoniae,K.pn)为主要病原菌,占89.6%,其检出率在2组间差异有统计学意义(P<0.05);所有菌株对替加环素敏感,对亚胺培南、哌拉西林/他唑巴坦、头孢吡肟均具有较高的敏感性,>89%;对氨苄西林、复方新诺明的敏感性较差,均<40%;E.coli对氨苄西林、复方新诺明、头孢曲松、左旋氧氟沙星、头孢吡肟耐药率及ESBLs携带率在2组之间差异均有统计学意义(P<0.05)。结论2组患者在FIB、病程、培养阳性率、主要致病菌种类、耐药性等方面均有差异,因此区分患者是否合并糖尿病应成为临床医生在肛周脓肿患者的诊治过程中关注点之一,并依此制定个性化治疗方案,减少细菌耐药和二重感染的发生。

Objective To analyze the clinical features,pathogenic bacteria and the drug resistance of pathogenic bacteria between diabetic and non-diabetic perianal abscess patients.Methods To compare the difference in the positive rate of abscess culture,the types of pathogenic bacteria and the drug resistance.Results The total positive rate of pus culture was 69.3%.E.coli and K.pn were the main pathogenic bacteria,accounting for 89.6%.The detection rates of E.coli and K.pn were significantly different between the two groups(P<0.05);all E.coli and K.pn were sensitive to tigacycline,and all highly sensitive to amperonam,piperacillin/tazobactam,cefepime(>89%)and less sensitive to ampicillin and trimethoprim(<40%);there are differences in the resistant rate to ampicillin,levofloxacin,cefepime,trimethoprim,ceftriaxone and the ESBLs carrier rates of E.coli between the two groups(P<0.05).Conclusion There are differences in FIB,course of disease,positive rate of culture,main pathogenic bacteria and antibiotic resistance between the two groups.Therefore,it should be one of the focuses of clinicians in the diagnosis and treatment of patients with perianal abscess to distinguish between the two groups.And individualized treatment protocols are formulated to reduce bacterial resistance and double infection.