肛周脓肿病原菌分布及耐药性分析

为探讨肛周脓肿病原菌分布及对常用抗菌药物的耐药性，选取山东省千佛山医院肛肠科2013年9月23日至2014年4月23日收治58例肛周脓肿患者进行研究，对其脓液进行革兰染色、病原菌培养及药敏试验。结果显示，58例患者中，4例未培养出细菌，其余54例共分离出病原菌67株（其中革兰阴性菌54株，占80．6％；革兰阳性菌13株，占19．4％）；检出菌株数居首位的为大肠埃希菌（41株，61．2％），其次为肺炎克雷伯菌（7株，10．4％）。大肠埃希菌及肺炎克雷伯菌对常用抗菌药物敏感率较低，耐药性较高，尤其是对氨苄西林的耐药性较强，但对头孢西丁、美罗培南、亚胺培南、阿米卡星、厄他培南、替卡西林／克拉维酸、哌拉西林／他唑巴坦高度敏感。多重耐药11例，其中9例为大肠埃希菌感染多重耐药（ESBLS阳性），2例为葡萄球菌感染多重耐药。9例ESBLS阳性大肠埃希菌感染者对头孢噻肟100％耐药，对头孢西丁、美罗培南、亚胺培南、阿米卡星、哌拉西林／他唑巴坦、厄他培南、替卡西林／克拉维酸未见耐药。结果表明，肛周脓肿病原菌以革兰阴性杆菌为主，治疗时应首选抗革兰阴性杆菌的药物，并采取积极办法应对病原菌的多重耐药，可选替卡西林／克拉维酸、哌拉西林／他唑巴坦等含酶抑制剂的抗菌药物。

Analysis on the Distribution and Drug-resistance of Pathogens at Perianal Abscess

In order to investigate the distribution and drug-resistance of pathogens at perianal abscess authors recruited 58 patients with perianal abscess treated in Qianfoshan hospital of Shandong province from 2013-09-23 to 2014-04-23 ,and took G staining,pathogen culture and drug-sensitive test for patient＇s pus.As results, from the pus in 54 of 58 cases 67 strains of pathogens were isolated included 54 strains of G- bacteria accounted 80.6% ,while,G^＋ , 13,19.4% ;isolated pathogens in turn was E.coli （41 strains,accounted 61. 2%）, Klebsiella pneumoniae （7,10.4%） ,which both all had higher drug-resistomce and lower sensitivity to common antibacterials,especialy,higher drug-resistance to Ampicillin,high sensitive to Cefoxitin,Meropenem, Imipenem, Amikacin, Ertapenem, Ticarcillin/Clavulanic acid, Piperacillin/Tazobactam; 11 cases were of multi drug-resistance to E.coli （9 of ESBLs＋ ,2 of multi drug-resistance to Staphylococcus ）,the 9 cases of ESBLs＋ were only of drugs-resistance to Cefotaxime,without drugs-resistance to other drugs.Results show that owing to perianal abscess pathogens being predominated by G- bacteria it should be to first choice anti-G- bacteria drugs for treatment of abscess, and actively to cope multi drug-resistance, thus some contained-enzyme inhibitive anti-bacteria drugs like as Ticarcillin/clavulanic acid, Piperacillin/ Tazobactam,etc could be selected.