文章摘要

肝切除术后腹腔感染的病原菌及耐药性分析

作者: 1王 宇晖, 1左 道宏, 1王 志明
1 中南大学湘雅医院 普通外科,湖南 长沙 410008
通讯: 王 志明 Email: wangzhiming008@163.com
DOI: 10.3978/.2018.07.013

摘要

目的:探讨肝切除术后腹腔感染患者的病原菌分布及耐药性、患者临床病理特征与感染类型的关系。
方法:回顾性分析 2013 年 1 月—2017 年 12 月收治的 95 例行肝切除术后继发腹腔感染的患者的临床资料及病原菌结果。单因素和多因素 Logistic 回归分析患者临床资料与感染类型的相关性。
结果:95 例患者共培养得到非重复菌株 170 株,单独感染 55 例(57.9%),混合感染 40 例(42.1%);其中革兰氏阴性菌 80 株(47.1%),革兰氏阳性菌 83 株(48.8%),真菌 7 株(4.1%)。排名前 5 的病原菌依次是大肠埃希菌(15.3%),屎肠球菌(14.7%),肺炎克雷伯菌(12.4%),粪肠球菌(11.2%),表面凝固酶阴性葡萄球菌(8.2%)。耐药分析显示,大肠埃希菌和克雷伯菌属产超广谱 β- 内酰胺酶(ESBLs)菌株检出率分别为 76.9%、37.5%,两者对头孢哌酮 / 舒巴坦的敏感度分别为 66.7%、 70.0%,对亚胺培南的敏感度分别为 100.0%、79.2%。鲍曼不动杆菌除对替加环素保持 100.0% 敏感外,其余主要抗生素敏感度均在 30.0% 以下。44 株屎 / 粪肠球菌中未发现万古霉素耐药株,其对万古霉素的敏感度分别为 92.0%、89.5%。14 株表面凝固酶阴性葡萄球菌全部表现为耐甲氧西林菌株,对万古霉素和利奈唑胺保持 100.0% 敏感度。Logistic 回归分析显示,术后腹腔内并发症是混合感染的独立危险因素(P=0.006)。
结论:肝切除术后腹腔感染中革兰氏阳性菌比例较高,以肠球菌属为主。革兰氏阴性菌中耐碳青霉烯类药物肠杆菌比例有增加趋势,多重耐药现象严重。术后腹腔内并发症是混合感染的独立危险因素。
关键词: 肝切除术;腹腔内感染;细菌;抗药性,细菌

Intra-abdominal infection after hepatectomy: analysis of pathogens and antimicrobial resistance

Authors: 1Yuhui WANG, 1Daohong ZUO, 1Zhiming WANG
1 Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China

CorrespondingAuthor:Zhiming WANG Email: wangzhiming008@163.com

Abstract

Objective: To investigate the distribution of pathogens isolated from patients with intra-abdominal infection aft er hepatectomy and their antimicrobial resistances as well as the relations of the clinicopathologic profiles of the patients with the type of infection.
Methods: The clinical data and microbiological profiles of 95 patients with intra-abdominal infection after hepatectomy from January 2013 to December 2017 were retrospectively analyzed. The relationship between the clinical data of the patients and types of infections were determined by univariate and multivariate Logistic regression analyses.
Results: Of the 95 patients, a total of 170 non-duplicate bacterial strains were isolated from culture media, 55 cases (57.9%) had single infection and 40 cases (42.1%) had mixed infection, including 80 Gram-negative bacteria (47.1%), 83 Gram-positive bacteria (48.8%) and 7 fungi (4.1%). The top five common pathogens isolated were Escherichia coli (15.3%), Enterococcus faecium (14.7%), Klebsiella pneumonia (12.4%), Enterococcus faecalis (11.2%), and Coagulase-negative staphylococci (8.2%), respectively. Antimicrobial susceptibility testing showed that the detection rate of extended-spectrum β-lactamases (ESBLs) in Escherichia coli and Klebsiella pneumonia was 76.9% and 37.5%, respectively. The susceptible rate of Escherichia coli and Klebsiella pneumonia to cefperazone-sulbactam was 66.7% and 70.0%, and to imipeniem was 100.0% and 79.2%, respectively. The susceptible rate of Acinetobacter baumannii to major antibiotics was lower than 30% except tigecycline (susceptible rate 100%). No resistance to vancomycin was found in the 44 isolates of Enterococcus faecium/faecalis, and their susceptible rate to vancomycin was 92.0% and 89.5%, respectively. All the 14 isolates of coagulase-negative staphylococci were methicillin-resistant coagulase-negative staphylococci and their susceptible rates to vancomycin and linezolid were maintained at 100%. Logistic regression analysis results showed that occurrence of postoperative intraperitoneal complications was an independent risk factor for mixed infection (P=0.006).
Conclusion: Gram-positive bacteria, especially the Enterococcus species are dominant pathogens associated with intra-abdominal infection after hepatectomy. Of gram-negative bacteria, the proportion of Carbapenem-resistant Enterobacteriaceae shows an increasing trend with severe multidrug resistance problems. Occurrence of postoperative intraperitoneal complications is an independent risk factor for mixed infection.
Keywords: Hepatectomy; Intraabdominal infections; Bacteria; Drug Resistance Bacterial