细菌性肝脓肿病原学分布及抗菌药物应用

Pathogenic distribution of bacterial liver abscess and application of antibiotics

目的 研究分析细菌性肝脓肿病原学分布及抗菌药物应用。方法 选取滕州市中心人民医院门诊在2018年7月—2022年7月收治的80例肝脓肿患者为研究对象,对患者肝穿刺脓液标本进行涂片检查以及病原菌培养,分析统计细菌性肝脓肿的病原学分布、耐药性以及抗菌药物的应用情况。结果 80例患者中,细菌培养呈阳性为59例,阳性率为73.75%,其中革兰阳性菌7株(金黄色葡萄球菌、中间链球菌、嗜水气单胞菌、产气荚膜梭菌、颗粒链球菌),约占11.86%,革兰阴性菌为52株(大肠埃希菌、肺炎克雷伯菌),约占88.14%,肺炎克雷伯菌46例,约占77.97%。肺炎克雷伯菌药敏试验结果显示,头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、亚胺培南、头孢噻肟、头孢呋辛、复方新诺明、庆大霉素、妥布霉素、左氧氟沙星、头孢西丁、氨曲南和美罗培南敏感度均>86.00%,其中头孢哌酮/舒巴坦以及哌拉西林/他唑巴坦敏感度最高,为100.00%,氨苄西林天然耐药敏感度为0.00%。结论 细菌性肝脓肿的主要致病菌为肺炎克雷伯菌,临床用药主要以喹诺酮类、氨基糖苷类、碳青霉烯类药物为推荐用药。

Objective To study and analyze the pathogenic distribution of bacterial liver abscess and the application of antibiotics.Methods A total of 80 patients with liver abscess admitted in Tengzhou Central People's Hospital,outpatient department from July 2018 to July 2022 were selected as the research objects.The liver puncture pus samples were smeared and cultured for pathogens,and the distribution of pathogens,drug resistance and application of antibacterial agents of bacterial liver abscess were analyzed and counted.Results Among 80 patients,59 were positive in bacterial culture,with a positive rate of 73.75%.Among them,7 strains of Gram positive bacteria(Staphylococcus aureus,Streptococcus intermedius,Aeromonas hydrophila,Clostridium perfringens,Streptococcus granatum)accounted for 11.86%,52 strains of Gram negative bacteria(Escherichia coli,Klebsiella pneumoniae)accounted for 88.14%,and 46 strains of Klebsiella pneumoniae accounted for 77.97%.The drug sensitivity test results of Klebsiella pneumoniae showed that the sensitivity of cefoperazone/sulbactam,piperacillin/tazobactam,cefepime,ceftazidime,imipenem,cefotaxime,cefuroxime,compound sulfamethoxazole,gentamycin,tobramycin,levofloxacin,cefoxitin,aztreonam and meropenem were all more than 86.00%,of which the sensitivity of cefoperazone/sulbactam and piperacillin/tazobactam was the highest(100.00%).The sensitivity of ampicillin was 0.00%.Conclusion The main pathogen of bacterial liver abscess was Klebsiella pneumoniae.Quinolones,aminoglycosides and carbapenems were recommended drugs for clinical use.