肛周脓肿主要病原菌分析及术后抗菌药物治疗效果探讨

Analysis of Main Pathogenic Bacteria in Perianal Abscess and Discussion on Therapeutic Effect of Postopera-tive Antibiotics

目的:探讨肛周脓肿患者的主要病原菌及耐药情况,分析术后抗菌药物的治疗效果,为肛周脓肿患者的治疗提供参考。方法:回顾性分析本院2021年1~12月,行手术治疗的284例肛周脓肿患者,分析患者脓液病原菌分布、药敏情况,并将病原菌为产ESBL的大肠埃希菌患者,依据使用的抗菌药物是否敏感进行分组,比较2组住院时间、白细胞及中性粒细胞百分比等指标。结果:205例患者脓液标本共分离病原菌195珠,前3位分别是大肠埃希菌(66.7%)、肺炎克雷伯菌(17.4%)和聚团肠杆菌(4.1%),均为革兰阴性菌,革兰阳性菌相对较少,主要为葡萄球菌类(2.0%)。大肠埃希菌对复方磺胺甲噁唑、氨苄西林耐药率最高,达70%以上。对头孢哌酮舒巴坦、阿米卡星耐药率低于10%,未发现对亚胺培南西司他丁、美罗培南耐药的菌株,肺炎克雷伯菌对除阿米卡星、氨苄西林外的其他药物的耐药率均低于大肠埃希菌。敏感组与非敏感组患者的术后抗菌药物使用时间、住院时间及白细胞计数、中性粒细胞百分比比较差异均无统计学意义(P>0.05)。结论:肛周脓肿患者病原菌以革兰阴性菌的大肠埃希菌和肺炎克雷伯菌为主,且使用的抗菌药物是否对病原菌敏感对术后治疗效果的影响不大。

Objective To investigate the main pathogenic bacteria and drug resistance of patients with perianal abscess,analyze the therapeutic effect of postoperative antibiotics,and provide reference for the treatment.Methods Total 284 patients with perianal abscess who underwent surgical treatment in our hospital from January to December 2021 were retrospectively analyzed,and the distribution of pathogenic bacteria and drug sensitivity in the pus of the patients were analyzed.Patients with ESBL-producing Esch-erichia coli were grouped according to whether the antibiotics used were sensitive or not,and the indexes such as length of hospital stay,percentage of white blood cells and neutrophil were compared between the two groups.Results A total of 195 pathogenic bacteria were isolated from the pus samples of 205 pa-tients.The top 3 were Escherichia coli(66.7%),Klebsiella pneumoniae(17.4%)and Enterobacter cluster(4.1%),all of which were gram-negative bacteria,while the gram positive bacteria were relatively few,mainly staphylococcus(2.0%).The resistance rate of Escherichia coli to compound sulfamethoxazole and ampicillin was the highest,reaching more than 70%.The resistance rate to cefoperazone-sulbactam and amikacin was less than 10%.No strains resistant to imipenem cilastatin and meropenem were found.The resistance rate of Klebsiella pneumoniae to other drugs except amikacin and ampicillin was less than that of Escherichia coli.There were no significant differences in duration of antibiotic use,the length of hospital stay,white blood cell count and neutrophil percentage between sensitive group and non-sensitive group(P>0.05).Conclusion The main pathogenic bacteria in patients with perianal abscess are gram-negative Escherichia coli and Klebsiella pneumoniae,and whether the antibiotics used are sensitive to the pathogens has little influence on the postoperative treatment.