肛周脓肿病原菌分布及耐药性分析

Distribution of the pathogens causing perianal abscess and analysis of drug resistance

关键词:  肛周脓肿  病原菌  耐药性

Key words:  perianal abscess  ptheathogens  characteristics of drug resistant

摘要:

目的　通过对肛周脓肿病原学检测和耐药性分析，指导临床合理使用抗菌药物，减少耐药菌株的产生。方法　对唐山市中医医院145例肛周脓肿患者的脓液进行细菌培养、鉴定和药敏试验，并对药敏结果进行统计分析。结果　145例标本中共检出病原菌109株，阳性率为75.2%，均为单一性感染，其中革兰阴性杆菌75株（68.8%），以大肠埃希菌（39.4%）和肺炎克雷伯菌（16.5%）为主，产超广谱β-内酰胺酶（ESBLs）菌株占革兰阴性杆菌的25.3%；革兰阳性球菌32株（29.4%），以肠球菌（11.9%）和金黄色葡萄球菌（8.4%）为主，耐甲氧西林金黄色葡萄球菌（MRSA）占44.4%；白假丝酵母菌2株（1.8%）。大肠埃希菌对氨苄西林、头孢唑林、甲氧苄啶/磺胺甲恶唑耐药率较高，依次为81.4%、62.8%、58.1%，未发现碳青霉烯类、头孢替坦、哌拉西林/他唑巴坦耐药菌株；肠球菌属对红霉素、苄青霉素、四环素耐药率较高，依次为92.3%、84.6%、69.2%，未发现万古霉素、利奈唑胺、替加环素耐药菌株。结论　肛周脓肿的主要致病菌为大肠埃希菌，各病原菌均存在不同程度的耐药性，应根据细菌培养和药敏试验结果合理使用抗菌药物，以减少耐药菌株的产生。

Abstract:

Objective To investigate distribution of the pathogens causing perianal abscess as well as the characteristics of drug resistance in order to guide intelligent use of antimicrobial agents and reduce emergence of resistance clinically. 　Methods　Bacterial culture, identification and drug resistant test were performed on 145 patients with perianal abscess, and the results were statistically analyzed. 　Results　Totally, 109 strains of pathogens were isolated from 145 samples with a positive rate of 75.2%. All pathogens were single infection, including 75 strains of gram-negative bacteria (68.8%), mainly Escherichia coli (39.4%) and Klebsiella pneumonia (16.5%)，and the prevalence of ESBLs-producing strains was 25.3% in gram-negative bacteria；32 strains of gram-positive bacteria (29.4%), mainly Enterococcus (11.9%) and Staphylococcus aureus (8.4%), and the overall prevalence of methicillin-resistance was 44.4% in S.aureus (MRSA)；and 2 strains of Candida albicans (1.8%). E.coli showed high resistance to ampicillin, cefazolin and trimethoprim-sulfamethoxazole with resistant rates 81.4%, 62.8%, and 58.1%, respectively and no strains were found resistant to carbapenems, cefotetan and piperacillin-tazobactam. Enterococcus showed high resistance to erythromycin, benzylpenicillin, tetracycline with resistant rates 92.3%, 84.6% and 69.2% respectively and no strains were found resistant to vancomycin, linezolid and tigecycline. 　Conclusion E.coli are the main pathogens causing perianal abscess and each pathogen has different degree of drug resistance. In order to reduce the occurrence of drug-resistant strains, it is necessary for the clinician to use antibiotics intelligently according to the results of bacterial culture and antimicrobial susceptibility testing.