肠外瘘并发腹腔感染的细菌学与耐药性分析

调查肠外瘘并发腹腔感染的主要致病菌和对常用抗生素的耐药性。材料与方法:取79例作腹腔脓液培养和抗生素药物敏感试验。导致肠外瘘的原因分别为胃肠手术30例(38.0%),外伤27例(34.1%),胰腺手术和重症胰腺炎14例(17.7%),肝胆手术4例(5.1%),腹腔放疗或化疗后4例(5.1%)。结果:共培养细菌153株,其中居前十位的细菌依次为大肠埃希菌38株(25%),铜绿假单胞菌19株(12%),金黄色葡萄球菌17株(11%),阴沟肠杆菌16株(10%),肺炎克雷伯菌13株(8%),鲍曼不动杆菌6株(4%),摩根摩根菌和产酸克雷伯菌各5株(各3%),普通变形菌、粘质沙雷菌和粪肠球菌各4株(各3%)。肠瘘并发腹腔感染的致病菌以革兰阴性菌为主,共122株(79.7%);革兰阳性菌为31株(20.3%)。大肠埃希菌和肺炎克雷伯菌中超广谱β-内酰胺酶(ESBL)阳性率平均为41%(21例)。17株金黄色葡萄球菌均为甲氧西林耐药(MRSA)。结论:肠外瘘并发腹腔感染的致病菌以革兰阴性菌为主,其呈ESBL阳性者较高,金黄色葡萄球菌则全为MRSA。这些致病菌均属多重耐药。因此,对肠外瘘合并腹腔感染者,除手术治疗外,还需注意合理使用抗生素。

Microbiologic Study in Gastrointestinal Fistula Patients Complicated with Abdominal Infection.

To carry out the bacteriologic study of the infected foci in patients with gastrointesti-nal fistulas and pertiment drug resistance profile of the bacteria involved. Methods: A total of 79 caseswere analyzed. The complication occurred after gastrointestinal operations(38.0%), abdominal trauma(34.1%), pancreatic operations/severe pancreatitis(17.7%), hepato-biliary operations(5.1%) or radiation in-jury(5.1%). Results: Gram-negative bacteria were the main pathogens(79.7%). Forty-one percent of Es-cherichia coli and Klebsiella pneumoniae expressed extended broad spectrum beta-lactamase(ESBL). AllStaphylococcus aureus were Methicillin resistant. Escherichia coli(25%), Pseudomonas aeruginosa(12),Staphylococcus aureus(11%), Enterobacter cloacae(10%) and Klebsiella pneumoniae(8%) ranked the top 5bateria cultured. Conclusions: Microbiologic analysis leading to an appropriate antibiotic therapy is of para-mount importance in the management of gastrointestinal fistula complicated with abdominal infection.