肝细胞癌患者肝部分切除术后腹腔感染病原微生物及耐药性分析

Analysis of pathogenic microorganisms and drug resistance in abdominal infection of patients with hepatocellular carcinoma after partial hepatectomy

目的分析肝细胞癌患者肝部分切除术后引发腹腔感染的病原微生物分布及其耐药性。方法选取2021年1月至2023年5月我院收治行肝部分切除术后并发腹腔感染肝细胞癌患者65例作为研究对象,回顾性分析其腹腔引流液病原菌分离培养及药敏试验结果。结果65例患者腹腔引流物样本共分离出病原菌108株,其中单独感染38例(58.5%),多重感染27例(41.5%)。培养得到革兰阴性菌55株(50.9%),其中以大肠埃希菌(17株,15.7%)、肺炎克雷伯菌(15株,13.9%)最多;革兰阳性菌48株(44.4%),其中以屎肠球菌(16株,14.8%)、粪肠球菌(12株,11.1%)、金黄色葡萄球菌(8株,7.4%)最多;真菌5株(4.6%),其中以白假丝酵母菌最多(3株,2.8%)。药敏试验结果显示,大肠埃希菌对二代头孢、部分三代头孢、氟喹诺酮类药物敏感性较低,对复合类制剂、部分三代头孢、四代头孢、碳青霉烯类、氨基糖苷类及四环素类药物敏感性较高;肺炎克雷伯菌对二代头孢类药物敏感性较低,对复合类制剂、三代头孢、四代头孢、碳青霉烯类、氟喹诺酮类、氨基糖苷类、四环素类药物敏感性较高;屎肠球菌、粪肠球菌对林可霉素类、大环内酯类药物敏感性较低,对青霉素类、氨基糖苷类、氟喹诺酮类、四环素类和糖肽类药物敏感性较高,其中粪肠球菌对阿莫西林敏感性也较低;金黄色葡萄球菌对青霉素类、氨基糖苷类、氟喹诺酮类、林可霉素类、大环内酯类药物敏感性较低,对四环素类、糖肽类药物敏感性较高。结论导致肝细胞癌患者肝部分切除术后腹腔感染的病原微生物是以大肠埃希菌等为代表的革兰阴性菌,其与以屎肠球菌为代表的革兰阳性菌尚未对常用抗菌药物产生显著耐药性,临床治疗过程中可使用经验性抗菌药物,同时加强监控与预防,严格遵循用药规范。

Objective To analyze the distribution and drug resistance of pathogenic microorganisms in abdominal infection of patients with hepatocellular carcinoma after partial hepatectomy.Methods A total of 65 patients with hepatocellular carcinoma complicated with abdominal infection after partial hepatectomy in our hospital from January 2021 to May 2023 were selected as the study subjects,and the results of isolation,culture and drug sensitivity test of pathogenic bacteria in abdominal drainage fluid were retrospectively analyzed.Results A total of 108 strains of pathogenic bacteria were isolated from the abdominal drainage samples of 65 patients,and there were 38 cases(58.5%)of single infection and 27 cases(41.5%)of multiple infection.Fifty-five strains of Gram-negative bacteria(50.9%)were obtained,of which Escherichia coli(17 strains,15.7%)and Klebsiella pneumoniae(15 strains,13.9%)were the most.There were 48 strains of Gram-positive bacteria(44.4%),mostly Enterococcus faecium(16 strains,14.8%),Enterococcus faecalis(12 strains,11.1%)and Staphylococcus aureus(8 strains,7.4%).There were 5 fungal strains(4.6%),mainly Candida albicans(3 strains,2.8%).Drug sensitivity test showed that Escherichea coli was lowly sensitive to second-generation cephalosporin,partly third-generation cephalosporin and fluoroquinolones,but was highly sensitive to compound preparations,partly third-generation cephalosporin,fourth-generation cephalosporin,carbapenems,aminoglycosides and tetracyclines.Klebsiella pneumoniae had low sensitivity to second-generation cephalosporin,but had high sensitivity to compound preparations,third-generation cephalosporin,fourth-generation cephalosporin,carbapenems,fluoroquinolones,aminoglycosides and tetracyclines.Enterococcus faecium and Enterococcus faecalis were lowly sensitive to lincomycin and macrolides,and highly sensitive to penicillins,aminoglycosides,fluoroquinolones,tetracyclines and glycopeptides.Enterococcus faecalis was also lowly sensitive to amoxicillin.Staphylococcus aureus had low sensitivity to penicillins,aminoglycosides,fluoroquinolones,lincomycin and macrolides,but had high sensitivity to tetracyclines and glycopeptides.Conclusion The pathogenic microorganisms that cause abdominal infection in patients with hepatocellular carcinoma after partial hepatectomy are Gram-negative bacteria represented by Escherichia coli,and Gram-positive bacteria represented by Enterococcus faecium have not yet developed significant resistance to commonly used antibiotics.It is necessary to use empirical antibiotics in the clinical treatment process,strengthen the monitoring and prevention and strictly follow the medication guidelines.