肛周脓肿感染肠杆菌科细菌分布及药敏试验结果分析

目的通过对肛周脓肿患者感染肠杆菌科细菌的分布情况及其药敏分析,为临床合理使用抗生素提供依据。方法选取大理白族自治州中医医院2016年1月至2018年12月收治的638例肛周脓肿的患者作为研究对象,分析肛周脓肿穿刺液培养检出肠杆菌科细菌的结果。结果557株肠杆菌科细菌中大肠埃希菌464株(83.3%),产超广谱β-内酰胺酶157株(33.8%);其次是肺炎克雷伯菌54株(9.69%),产超广谱β-内酰胺酶1株(1.9%);奇异变形杆菌18株(3.23%),产超广谱β-内酰胺酶1株(5.6%)。大肠埃希菌敏感率大于80.0%的抗菌药物有阿米卡星、厄他培南、美罗培南、头孢他啶、头孢西丁、头孢哌酮/舒巴坦、亚胺培南、哌拉西林/三唑巴坦。肺炎克雷伯菌敏感率大于80.00%的抗菌药物有阿米卡星、阿莫西林/克拉维酸、氨曲南、厄他培南、环丙沙星、氯霉素、美罗培南、庆大霉素、替卡西林/克拉维酸、头孢他啶、头孢西丁、头孢呋辛、头孢吡肟、头孢哌酮、头孢哌酮/舒巴坦、头孢噻肟、妥布霉素、亚胺培南、左氧氟沙星、哌拉西林/三唑巴坦。奇异变形杆菌敏感率大于80.0%的抗菌药物有阿米卡星、阿莫西林/克拉维酸、厄他培南、氯霉素、美罗培南、庆大霉素、替卡西林/克拉维酸、头孢哌酮/舒巴坦、亚胺培南、哌拉西林/三唑巴坦、氨苄西林/舒巴坦。结论治疗大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌引起的肛周脓肿,经验使用抗菌药时,可选用头孢他啶、头孢西丁、阿米卡星,对于存在多重耐药菌感染高风险的患者,需考虑产超广谱β-内酰胺酶细菌感染可能,可选用头孢哌酮/舒巴坦、哌拉西林/三唑巴坦,重症感染时首选亚胺培南、美罗培南进行抗感染治疗。

The Distribution of Enterobacteriaceae in Perianal Abscess Infection and Analysis of Drug Sensitivity Test Results

Objective The distribution and drug sensitivity of enterobacteriaceae infection in patients with perianal abscess were analyzed,It provides the basis for clinical rational use of antibiotics.Methods A total of 638 patients with perianal abscess admitted to Dali Bai Autonomous Prefecture Chinese Medicine Hospital from January 2016 to December 2018 were selected as the study subjects.The results of culture enterobacteriaceae from perianal abscess puncture fluid were analyzed.Results Among the 557 strains of Enterobacteriaceae,464 strains(83.3%)of Escherichia coli,of which 157 strains(33.8%)produced extended-spectrumβ-lactamase.Followed by 54 strains of Klebsiella pneumoniae(9.69%),of which 1 strain(1.9%)produced extended-spectrumβ-lactamase.The remaining 18 strains are Proteus mirabilis(3.23%),of which one strain(5.6%)produces extended-spectrumβ-lactamase.The drug susceptibility rate of amikacin,ertapenem,meropenem,ceftazidime,cefoxitin,cefoperazone/sulbactam,imipenem and piperacillin/tazobactam to Escherichia coli are more than 80.00%.The drug susceptibility rate of amikacin,amoxicillin/clavulanic acid,aztreonam,ertapenem,ciprofloxacin,chloramphenicol,meropenem,gentamicin,ticarcillin/clavulanic acid,ceftazidime,cefoxitin,cefuroxime,cefepime,cefoperazone,cefoperazone/sulbactam,cefotaxime,tobramycin,imipenem,levofloxacin and piperacillin/tazobactam to Klebsiella pneumoniae aremore than 80.00%.The drug susceptibility rate of amikacin,amoxicillin/clavulanic acid,ertapenem,chloramphenicol,meropenem,gentamicin,ticarcillin/clavulanic acid,cefoperazone/sulbactam,imipenem,piperacillin/tazobactam and ampicillin/sulbactam to Proteus mirabilisare are more than 80.00%.Conclusions For the treatment of perianal abscesses caused by Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis,ceftazidime,cefoxitin,and amikacin can be selected when using antibacterial drugs in experience.For patients at high risk of infection by multidrug resistant bacteria,the possibility of infection by extended-spectrumβ-lactamase-producing bacteria should be considered.Cefoperazone/sulbactam,piperacillin/tazobactam can be used,and the first choice for severe infections Imipenem and meropenem are used for anti-infective treatment.