摘要
目的分析重症急性胰腺炎(SAP)患者感染菌的菌群变化和耐药特征,指导临床合理使用抗菌药物。方法回顾分析2006年1月至2008年12月外科重症监护病房163例SAP患者腹腔内胰腺与胰腺周围采集的病原菌菌群和耐药性变化。结果共检出病原菌253株,其中革兰阴性菌197株,占77.9%,革兰阳性菌56株,占22.1%。所有检出病原菌中,革兰阴性菌所占比率最高,以不发酵糖菌为主,鲍曼不动杆菌、铜绿假单胞菌和嗜麦芽窄食单胞菌分别占19.8%、13.4%和9.9%,其中鲍曼不动杆菌和铜绿假单胞菌对抗菌药物的耐药性显著增加,并出现多重耐药和泛耐药菌株;大肠埃希菌与肺炎克雷伯菌所占比率分别为13.8%和13.0%,其产ESBLs株分别占45.7%和30.3%,并呈逐年上升趋势;革兰阳性菌比率较低,但肠球菌在胆道感染中所占比率较高(31.8%);常见葡萄球菌属和肠球菌属对替考拉宁、万古霉素和利奈唑胺保持高敏感性。结论重症急性胰腺炎细菌感染以革兰阴性菌为主,其中不发酵糖菌感染率和耐药率均明显上升,胆道阳性菌感染也有增加趋势,这些都对抗菌药物的合理应用提出了更高的要求。
Objective To study the changing pattern of pathogen strains and their resistance to antimicrobial agents in patients with severe acute pancreatitis （SAP） to aid rational antimicrobial chemotherapy. Methods The clinical data of 163 SAP patients admitted to surgical intensive care unit （SICU） between January 2006 and December 2008 were retrospectively analyzed in order to understand the changing pattern of pathogen strains and their resistance to antimicrobial agents. Results Of the 253 pathogens,197 （77.9%） were gram-negative bacteria; including A. baumannii （19.8%）,P. aeruginosa （13.4%）,S. maltophilia （9.9%）,56 （22.1%） were gram-positive pathogens. These nonfermenting gram-negative bacilli were the leading pathogens. The resistance of A. baumannii and P. aeruginosa increased in recent three years. Some multiple-resistant or pan-resistant strains were identified. E. coli and K. pneumoniae accounted for 13.8% and 13.0% of the pathogens. The prevalence of ESBLs-producing E. coli and K. pneumoniae was 45.7% and 30.3%,respectively. The prevalence of gram-positive bacteria was lower. Enterococcus strains were isolated in 31.8% of the patients with cholangitis. Staphylococcus and Enterococcus isolates were highly susceptible to teicoplanin,vancomycin and linezolid. Conclusions Gram-negative bacteria are the major pathogens of infection in SAP patients. Nonfermenting pathogens are increasingly resistant to antimicrobial agents in recent three years. Prevalence of gram-positive pathogens in patients with cholangitis is increasing.
出处
《中国感染与化疗杂志》
CAS
2009年第5期372-376,共5页
Chinese Journal of Infection and Chemotherapy
关键词
重症急性胰腺炎
感染
病原菌
耐药性
severe acute pancreatitis
infection
pathogen
resistance
