艾滋病肛周脓肿患者病原菌分布特征及抗菌药物应用分析

目的 通过分析艾滋病肛周脓肿患者病原菌分布及其主要病原菌的耐药性,指导临床合理应用抗菌药物。方法 回顾性分析杭州市西溪医院2017年1月-2021年10月艾滋病肛周脓肿患者细菌分布及药敏试验结果。结果 91例患者送检脓液样本54份,共分离出细菌68株,其中革兰氏阴性菌43株(63.24%)、革兰氏阳性菌23株(33.82%)、真菌2株(2.94%)。革兰氏阴性菌产超广谱β-内酰胺酶菌株检出率25.58%,对亚胺培南、厄他培南、阿米卡星、头孢替坦、头孢吡肟、哌拉西林他唑巴坦耐药率低,大肠埃希菌对氨苄西林、氨苄西林/舒巴坦、头孢曲松、左氧氟沙星、环丙沙星及复方新诺明耐药率>40%。革兰氏阳性菌中链球菌属占47.83%,对克林霉素耐药率100%,未发现对万古霉素、利奈唑胺耐药菌株。结论 艾滋病肛周脓肿患者致病菌以革兰氏阴性菌大肠埃希菌、肺炎克雷伯菌为主,还包括革兰氏阳性菌、真菌,经验性用药可选用四代头孢、β-内酰胺类酶抑制剂、头霉素类等,碳青霉烯类可作为经验性治疗效果不佳时的选择用药。

Distribution and Drug Resistance of Pathogens in Patients with AIDS Complicated with Perianal Abscess

OBJECTIVE To analyze the distribution and drug resistance of pathogens in patients with AIDS complicated with perianal abscess,so as to guide rational application of antibiotics in clinical practice.METHODS Retrospective analysis of bacterial distribution and drug susceptibility test results of patients with AIDS perianal abscess in Hangzhou Xixi Hospital from January 2017 to October 2021.RESULTS The 54 samples were sent from 91 patients and totaled 68 strains of bacteria were isolated,including 43 gram-negative bacteria (63.24%),23 gram-positive bacteria (33.82%),and 2 fungi (2.94%).The detection rate of gram-negative bacteria producing extended-spectrum β-Lactamase was 25.58%,and the resistance rate to imipenem,ertapenem,amikacin,cefotetan,cefepime,piperacillin and tazobactam was low.The resistance rate of Escherichia coli to ampicillin,ampicillin/sulbactam,ceftriaxone,levofloxacin,ciprofloxacin and compound trimethoprim was more than 40%.Among Gram-positive bacteria,Streptococcus accounted for 47.83%,and the resistance rate to clindamycin was 100%.No strains were found resistant to vancomycin and linezolid.CONCLUSION The pathogenic bacteria of AIDS patients with perianal abscess are mainly gram-negative bacteria Escherichia coli and Klebsiella pneumoniae,as well as gram-positive bacteria and fungi.The fourth generation cephalosporin and β-internal amidase inhibitors,cephalosporins can be selected when using antibacterial drugs in experience,carbapenems can be used when empirical treatment is not effective.