急性重症胰腺炎患者的病原菌分布及耐药性的临床研究
以前对坏死胰腺组织感染的研究众多，但对急性重症胰腺炎（SAP）治疗期间有关的全身性感染的研究是有限的。本研究目的是调查在过去三年里做过肝胆外科手术的SAP患者致病菌的分布和耐药性。我们对2008至2011年做过肝胆外科手术的SAP患者致病菌的分布，类别和药物耐药性进行了回顾性研究分析。 共对594致病菌样本进行分离。其中418例（70.4％）是革兰阴性菌，142例（23.9％）为革兰阳性菌，34例（5.7％）为真菌。最常见的革兰氏阴性菌是大肠杆菌（19.8％），最主要的的革兰氏阳性致病菌是肠球菌。SAP相关的传染性病原体的分布主要集中在腹腔引流液，痰，胆汁和伤口分泌物。几乎所有的革兰氏阴性致病菌对碳青霉烯类敏感。 产超广谱β-内酰胺酶（ESBLs）菌株比非产ESBLs菌株对青霉素和头孢菌素更有耐药性。葡萄球菌对万古霉素和利奈唑胺敏感。耐甲氧西林葡萄球菌（MRS）对常用抗生素的耐药性比甲氧西林敏感的链球菌（MSS）更高。肠球菌属对万古霉素和利奈唑胺具有较低的耐药率。 在做过肝胆外科手术后的SAP相关感染中革兰氏阴性菌占主导地位。大量的真菌感染也有相关报道。细菌耐药率是很高的。根据感染部位，细菌的种类和药物的敏感性合理的使用抗生素，正确的治疗和加强洗手的过程，将有助于SAP相关感染的治疗和预防，并降低其死亡率。
吉林大学第一医院肝胆胰内科 沙秀娟 摘译
本文首次发表于[Chin Med J (Engl), 2012 , 125(10):1772-1776]
Clinical study of distribution and drug resistance of pathogens in patients with severe acute pancreatitis
BACKGROUND:
Previous researches about necrotic pancreatic tissue infections are numerous, but the study on systemic infection related to the severe acute pancreatitis (SAP) treatment period is limited. This study aimed to investigate the distribution and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP during the past three years.
METHODS:
A retrospective study was conducted on the distribution, category and drug resistance of pathogenic bacteria in patients who had hepatobiliary surgery for SAP from 2008 to 2011.
RESULTS:
A total of 594 pathogenic bacteria samples were isolated. Among them 418 isolates (70.4%) were Gram bacteria negative, 142 isolates (23.9%) were Gram bacteria positive, and 34 isolates (5.7%) were found fungi.The most common Gram negative bacteria were Escherichia coli (19.8%), and the dominant Gram positive pathogenic bacteria were Enterococcus faecium. The distribution of SAP-related infectious pathogens was mainly in peritoneal drainage fluid, sputum, bile, and wound secretions. Almost all the Gram negative pathogenic bacteria were sensitive to carbapenem. Extended-spectrum β-lactamases (ESBLs) producing strains were more resistant to penicillins and cephalosporins than the ESBLs non-producing strains. Staphylococcus was sensitive to vancomycin and linezolid. The drug resistance of methicillin-resistant staphylococcus (MRS) to commonly used antibiotics was higher than methicillin-sensitive streptococcus (MSS). Enterococcus sp. exhibited lower drug-resistance rates to vancomycin and linezolid.
CONCLUSIONS:
Gram negative bacteria were the dominant SAP-related infection after hepatobiliary surgery. A high number of fungal infections were reported. Drug resistant rates were high. Rational use of antibiotics according to the site of infection, bacterial species and drug sensitivity, correctly executing the course of treatment and enhancing hand washing will contribute to therapy and prevention of SAP-related infection and decrease its mortality.
