加权发病-综合征联合抗生素算法在社区获得性化脓性肝脓肿中的应用

Application of weighted incidence syndromic combined with antibiogram in community acquired pyogenic liver abscess

目的应用加权发病率综合征联合抗菌药物算法(WISCA)分析本院社区获得性化脓性肝脓肿患者细菌分布和耐药情况。方法筛选出住院且首次血液或肝脓肿穿刺引流液培养阳性的社区获得性肝脓肿患者113例,分离得细菌133株,采用法国生物梅里埃公司的VITEK-2 Compact进行细菌鉴定及药物敏感试验,统计分析细菌分布及耐药率,再应用WISCA计算各药物的加权敏感度。结果133株细菌中革兰阴性菌110株(82.7%),革兰阳性菌23株(17.3%)。革兰阴性菌中位列前2位的是肺炎克雷伯菌76株(57.1%)、大肠埃希菌24株(18.0%)。肺炎克雷伯菌仅对氨苄西林耐药率超过20%,对氨曲南、哌拉西林他唑巴坦、妥布霉素、头孢他啶、复方新诺明、左氧氟沙星、庆大霉素、环丙沙星、头孢唑林、头孢曲松、氨苄西林舒巴坦耐药率均低于大肠埃希菌。2种主要革兰阴性菌对厄他培南、哌拉西林他唑巴坦、亚胺培南、阿米卡星、头孢哌酮舒巴坦均保持20%以下的耐药率。高毒力肺炎克雷伯菌株与经典肺炎克雷伯菌株药敏比较差异无统计学意义(P>0.05)。加权敏感性超过80%且与其他抗革兰阴性菌抗菌药物比较有显著性差异的是亚胺培南(87.22%)。结论本院CA-PLA主要致病菌为肺炎克雷伯菌,其整体耐药率较低,未发现高毒力肺炎克雷伯菌耐药率超过经典肺炎克雷伯菌情况,亚胺培南可作为经验性覆盖CA-PLA致病菌的优先选择。

Objective To investigate distribution and drug resistance of bacteria causing community acquired pyogenic liver abscess(CA-PLA)with the weighted incidence syndromic combination antibiogram(WISCA)in our hospital.Methods A total of 133 strains were isolated from the first positive blood or purulent specimens from 113 CA-PLA patients.The bacteria identification and drug sensitivity test were performed using Merieux Alliance VITEK-2 Compact.The distribution of bacteria and their drug resistance were retrospectively analyzed,and then the WISCA was applied to calculate the weighted sensitivity of each drug.Results A total of 133 strains of pathogens were isolated during the study period,including 110(82.7%)strains of Gram-negative(G-)bacteria and 23(17.3%)strains of Gram-positive(G+)bacteria.The main two G-bacteria were Klebsiella pneumoniae strains(n=76,57.1%),Escherichia coli strains(n=24,18.0%).The resistance rate of Klebsiella pneumoniae to ampicillin was more than 20%.The resistance rate of Klebsiella pneumoniae to ampicillin,piperacillin tazobactam,tobramycin,ceftazidine,cotrimoxazole,levofloxacin,gentamicin,ciprofloxacin,cefazolin,ceftriaxone,ampicillin and sulbactam was lower than that of Escherichia coli.The resistance rates of the two major Gram-negative bacteria to ertapenem,piperacillin tazobactam,imipenem,amikacin,cefoperazone and sulbactam were less than 20%.There was no statistical significance on the difference in drug susceptibility between high virulence Klebsiella pneumoniae strain and classical Klebsiella pneumoniae strain(P>0.05).Imipenem(87.22%)had a weighted sensitivity of more than 80%and was significantly different from other antibiotics against Gram-negative bacteria.Conclusion Klebsiella pneumoniae was the main pathogen causing CA-PLA in our hospital,and its overall drug resistance rate was low.The drug resistance rate of highly virulent Klebsiella pneumoniae was not found to be higher than that of classical Klebsiella pneumoniae.Imipenem can be used as the priority for empirical coverage of CA-PLA pathogens.