天疱疮合并感染患者病原菌分布及耐药性

Distribution and antimicrobial resistance of pathogens in patients with pemphigus and infection

目的分析天疱疮合并感染患者病原菌的分布及耐药性,指导临床合理使用抗菌药物。方法回顾性选取某院2014年1月-2019年9月收治的天疱疮合并感染患者,分析病原菌分布及耐药情况,以及多重耐药菌(MDRO)感染的影响因素。结果共选取天疱疮合并感染患者114例,分离出121株病原菌,其中革兰阳性(G^+)菌73株(60.33%)、革兰阴性(G^-)菌26株(21.49%)、真菌22株(18.18%)。G^+菌主要来源于皮肤(70株,95.89%),主要为金黄色葡萄球菌(53株)、表皮葡萄球菌(10株)等。G^-菌主要来源于皮肤(14株,53.85%),其次为尿(6株,23.08%)、痰(5株,19.23%)。真菌主要来源于口腔黏膜(16株,72.72%)。共检出MDRO 37株(30.58%)。金黄色葡萄球菌、表皮葡萄球菌对青霉素的耐药率均为100%;金黄色葡萄球菌对氟喹诺酮类、头孢曲松、氨苄西林/舒巴坦、四环素的耐药率<50%,对克林霉素、红霉素的耐药率>90%。表皮葡萄球菌对氨苄西林/舒巴坦、庆大霉素、四环素、莫西沙星的耐药率<50%。耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林表皮葡萄球菌(MRSE)的检出率分别为43.40%、60.00%。未检测出对万古霉素、利奈唑胺、奎奴普丁/达夫普汀耐药的G^+菌。大肠埃希菌对大多数临床常用抗菌药物如第三代头孢、氟喹诺酮类、四环素的耐药率≤50%,对氨曲南的耐药率为30%,对头孢哌酮/舒巴坦、亚胺培南均敏感。疾病严重程度为中重度、伴有低蛋白血症的患者MDRO感染发病率较高,差异均有统计学意义(均P<0.05)。不同年龄、性别、口腔受累、糖尿病病史患者的MDRO感染发病率比较,差异均无统计学意义(均P>0.05)。结论天疱疮患者易继发各种感染,主要为皮肤细菌感染,且MDRO感染率高,病原菌及其耐药性具有一定特征。

Objective To analyze the distribution and antimicrobial resistance of pathogens in patients with pemphigus and infection, and guide rational clinical use of antimicrobial agents.Methods Patients with pemphigus and infection in a hospital from January 2014 to September 2019 were chosen retrospectively, distribution and antimicrobial resistance of pathogens, as well as influencing factors for multidrug-resistant organism(MDRO) infection was analyzed.Results A total of 114 patients with pemphigus and infection were chosen, and 121 strains of pathogens were isolated, including 73(60.33%) strains of Gram-positive(G^+) bacteria, 26(21.49%) Gram-negative(G^-) bacteria and 22(18.18%) fungi. G^+ bacteria were mainly isolated from skin(n=70, 95.89%), including 53 strains of Staphylococcus aureus(S. aureus) and 10 strains of Staphylococcus epidermidis(S. epidermidis). G^- bacteria were also mainly isolated from skin(n=14, 53.85%), followed by urine(n=6, 23.08%) and sputum(n=5, 19.23%). Fungi were mainly isolated from oral mucosa(n=16, 72.72%). A total of 37(30.58%) MDRO strains were isolated. Resistance rates of S. aureus and S. epidermidis to penicillin were both 100%;resistance rates of S. aureus to fluoroquinolones, ceftriaxone, ampicillin/sulbactam, and tetracycline were all <50%, resis-tance rates to clindamycin and erythromycin were both >90%. Resistance rates of S. epidermidis to ampicillin/sulbactam, gentamycin, tetracyclines and moxifloxacin were all <50%. Isolation rates of methicillin-resistant S. aureus(MRSA) and methicillin-resistant S. epidermidis(MRSE) were 43.40% and 60.00% respectively. Vancomycin-, linezolid-, and quinupristin/dalfopristin-resistant G^+ bacteria were not found. Resistance rates of Escherichia coli to most commonly used antimicrobial agents, such as the third generation cephalosporins, fluoroquinolones, and tetracyclines were all ≤50%, to aztreonam was 30%, Escherichia coli were sensitive to both cefoperazone/sulbactam and imipenem. Patients with moderate/severe disease and hypoproteinemia had a higher incidence of MDRO infection, differences were all statistically significant(all P<0.05). There was no significant difference in the incidence of MDRO infection among patients of different age, gender, oral involvement, and diabetes history(all P>0.05).Conclusion Patients with pemphigus are susceptible to all kinds of infection, mainly skin bacterial infection, MDRO infection rate is high, pathogenic bacteria and antimicrobial resistance have certain characteristics.