急性阑尾炎患者阑尾病灶组织分离的病原体及其耐药性分析

摘要

目的：了解急性阑尾炎患者中常见病原体及其对抗菌药物的耐药性，为临床选择抗菌药物治疗提供参考。方法对2011年1月至2013年12月收集的415例阑尾病灶组织标本采用法国生物梅里埃公司ATB半自动微生物鉴定仪进行细菌鉴定和药敏试验，对药敏结果采用WHONET5.6软件进行统计分析，并对大肠埃希菌、奇异变形杆菌、肺炎克雷伯菌进行了超广谱β-内酰胺酶(ESBL)检测。结果从415例阑尾病灶组织中分离出348株病原体，其中G-杆菌322株(92.52%)，G+球菌26株(7.47%)；检出率居前5位的病原菌依次为大肠埃希菌(76.14%)、铜绿色假单胞菌(6.90%)、奇异变形杆菌(3.45%)、肺炎克雷伯菌(3.16%)和粪肠球菌(1.44%)。药敏结果显示大肠埃希菌耐药率较低者依次为亚胺培南（0）、哌拉西林/他唑巴坦（0）、阿米卡星(5.3%)、头孢西丁(10.2%)和阿莫西林/克拉维酸(24.6%)，大肠埃希菌耐药率较高者依次为青霉素类抗生素类（86.8%~90.6%）、复方新诺明(67.9%)及第一、二代头孢菌素类药物(60.3%~67.9%)，G+球菌对万古霉素、替考拉宁、左旋氧氟沙星耐药率最低，对其他抗菌药物都有不同程度的耐药。ESBL确证试验结果显示，265株大肠埃希菌检出124株，产酶率为46.8%；奇异变形杆菌、肺炎克雷伯菌均未检出产ESBL菌株。结论急性阑尾炎感染细菌以G-杆菌为主，特别是以大肠埃希菌居首位；此菌对青霉素类、头孢类和喹诺酮类抗菌药物的耐药率逐年上升，特别是产ESBL菌株呈现出多药耐药现象严峻。应加强病原菌的检测和药敏试验，合理选择抗生素，减少耐药菌株的产生和扩散。%Objective To investigate the common pathogens isolated from lesion in patients of acute appen-dicitis and to analyze their drug resistance, in order to provide guidance for clinical selection of reasonable antibiotics. Methods A total of 415 samples of appendicitis lesions from January 2011 to December 2013 were collected. The bacteria identification and microbial sensitivity were performed using BioMerieux semi-automatic bacteria identifica-tion analyzer. The results of microbial sensitivity were analyzed by WHONET5.6 software. Extended spectrum beta lactamases (ESBL) on Escherichia coli, proteus, Klebsiella pneumoniae were also detected. Results A total of 348 strains of pathogens were isolated, including 322 strains of Gram-negative bacilli (92.52%), and 26 strains of Gram-positive cocci (7.47%). The top five pathogens detected were Escherichia coli (76.15%), Pseudomonas aerugino-sa (6.90%), Proteus mirabilis (3.45%), Klebsiella pneumoniae (3.16%) and Enterococcus faecalis (1.44%). The microbial sensitivity results showed that the drugs showed low resistance rate to E. coli included imipenem (0%), piperacil-lin-tazobactam (0%), amikacin (5.3%), cefoxitin (10.2%), amoxicillin-clavulanic acid 24.6%). and that the drugs with high resistance were penicillin antibiotic (86.6%~90.6%), and compound sulfamethoxazole (67.9%) and first and sec-ond generation cephalosporin drugs (60.3%~67.9%). G+cocci showed extremely low resistance to vancomycin, teico-planin, levofloxacin, and were resistant to other antimicrobial agents to varying degrees. Results of ESBL confirmato-ry test showed that 124 of the 265 strains (46.8%) of Escherichia coli were ESBL-producing. No ESBL-producing strains were detected in Proteus mirabilis and Klebsiella pneumoniae. Conclusion Acute appendicitis is mainly caused by G-nagative bacilli, especially Escherichia coli. The bacteria show increasing resistance to penicillin, cephalosporin and quinolone year by year, and the ESBL-producing strains, especially, show multi-resistance. We should strengthen pathogen detection and drug sensitivity test, choose antibiotics reasonably to reduce the generation and diffusion of drug-resistant strains.