【摘要】：目的:本文通過(guò)回顧性研究肝膽胰腺腫瘤患者術(shù)后發(fā)生感染收集的標(biāo)本進(jìn)行細(xì)菌培養(yǎng)及藥敏分析,明確肝膽胰腺腫瘤術(shù)后感染患者的病原菌分布及耐藥性情況,為術(shù)后感染合理使用抗生素提供依據(jù)。方法:收集河北醫(yī)科大學(xué)第四醫(yī)院東院肝膽外科2013年1月-2016年9月肝膽胰腺腫瘤病人,針對(duì)術(shù)后發(fā)生感染的標(biāo)本進(jìn)行細(xì)菌培養(yǎng)及藥敏試驗(yàn),統(tǒng)計(jì)分離出的感染細(xì)菌類別,并對(duì)分離出主要的幾種病原菌作為研究對(duì)象,對(duì)其常用抗生素的耐藥性進(jìn)行分析。細(xì)菌鑒定和抗生素藥敏試驗(yàn)使用BD Phoenix全自動(dòng)細(xì)菌鑒定及藥敏分析儀,按照CLSI 2016年版的標(biāo)準(zhǔn)判斷結(jié)果,以敏感(S)、中介(I)、耐藥(R)進(jìn)行區(qū)分。結(jié)果:1病原菌標(biāo)本來(lái)源:病原菌標(biāo)本來(lái)源以腹腔引流液為主,占93%,其他占7%;2病原菌分布及構(gòu)成比:從2013年1月~2016年9月收集術(shù)后發(fā)生感染的78人,共有124份培養(yǎng)出病原菌,培養(yǎng)出16種細(xì)菌,4種真菌,其中有13份標(biāo)本中檢出細(xì)菌合并真菌。分離出的病原菌包括革蘭氏陰性菌72份(52.55%),革蘭氏陽(yáng)性菌47份(34.31%),真菌18份(13.14%)。革蘭氏陰性菌主要包括肺炎克雷伯菌、大腸埃希菌、陰溝腸桿菌、銅綠假單胞菌、鮑曼氏不動(dòng)桿菌,分別占總病原菌數(shù)13.87%、10.95%、10.95%、4.38%和2.92%,革蘭氏陽(yáng)性菌主要包括屎腸球菌、金黃色葡萄球菌及糞腸球菌,分別占總病原菌數(shù)12.41%、8.03%及6.57%,真菌以白色念珠菌為主,占總病原菌數(shù)10.95%;3革蘭陰性細(xì)菌對(duì)常用抗生素的敏感率或耐藥率:革蘭陰性菌以桿菌為主,對(duì)碳青霉烯類如亞胺培南、美羅培南敏感,對(duì)丁胺卡那霉素也有很高的敏感性,對(duì)青霉素類及頭孢類具有較高的耐藥性;4革蘭陽(yáng)性細(xì)菌對(duì)常用抗生素的敏感率或耐藥率:革蘭陽(yáng)性菌以球菌為主,對(duì)萬(wàn)古霉素、利奈唑烷、替考拉寧等藥物具有較高敏感性,對(duì)青霉素類、喹諾酮類及頭孢類有較高的耐藥性;5真菌對(duì)伏立康唑較為敏感。結(jié)論:1肝膽胰腺腫瘤手術(shù)治療后導(dǎo)致感染的致病菌種以革蘭陰性菌為主,而其中肺炎克雷伯菌、大腸埃希菌、陰溝腸桿菌所致感染最多,對(duì)碳青霉烯類及丁胺卡那霉素較為敏感。2革蘭陽(yáng)性菌以屎腸球菌及溶血葡萄球菌所占比例最高,對(duì)萬(wàn)古霉素、利奈唑烷及替考拉寧等藥物具有較高敏感性。3真菌以白色念球菌為主,對(duì)伏立康唑較為敏感。
[Abstract]:Objective: to investigate the distribution of pathogenic bacteria and drug resistance in patients with hepatopancreatic neoplasms after operation by retrospectively studying the bacterial culture and drug sensitivity of the specimens collected from patients with hepatobiliary and pancreatic neoplasms. To provide the basis for rational use of antibiotics for postoperative infection. Methods: from January 2013 to September 2016, patients with hepatobiliary and pancreatic neoplasms in the Eastern Hospital of the fourth Hospital of Hebei Medical University were collected for bacterial culture and drug sensitivity test. Several main pathogens were isolated as the research object, and the antibiotic resistance of common antibiotics was analyzed. BD Phoenix automatic bacterial identification and antibiotic susceptibility test were used to identify the bacteria and the drug sensitivity analyzer. According to the standard judgment results of CLSI 2016 edition, the sensitive (S), intermediate (I), resistant (R) was distinguished. Results: (1) the origin of pathogenic bacteria: the main source of pathogenic bacteria was peritoneal drainage fluid (933%) and the other 7 (7%). (2) the distribution and composition of pathogenic bacteria: from January 2013 to September 2016, a total of 78 patients with postoperative infection were collected. A total of 124 pathogens were cultured, 16 kinds of bacteria and 4 kinds of fungi were cultured, of which 13 samples were found to have bacteria combined with fungi. The pathogens isolated included 72 Gram-negative bacteria (52.55%), 47 Gram-positive bacteria (34.31%) and 18 fungi (13.14%). Gram-negative bacteria mainly included Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Pseudomonas aeruginosa and Acinetobacter baumannii, which accounted for 13.87% and 2.92% of the total pathogenic bacteria, respectively. Gram-positive bacteria mainly included Enterococcus faecium, Staphylococcus aureus and Enterococcus faecalis, which accounted for 12.41% and 6.57% of the total pathogenic bacteria, respectively. The fungi were mainly Candida albicans, which accounted for 10.95% of the total pathogenic bacteria. 3 susceptibility or resistance of Gram-negative bacteria to common antibiotics: Gram-negative bacteria are mainly bacilli, sensitive to carbapenem such as imipenem, meropenem, and highly sensitive to amikacin. It has high resistance to penicillin and cephalosporins. 4 the susceptibility or drug resistance rate of Gram-positive bacteria to common antibiotics: Gram-positive bacteria were mainly cocci and highly sensitive to vancomycin, linazolane, teicoplanin, and penicillin. Quinolones and cephalosporins have higher resistance; 5 Fungi were sensitive to voliconazole. Conclusion: (1) Gram-negative bacteria were the main pathogenic bacteria of hepatobiliary and pancreatic tumor after operation, among which Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae were the most common. Gram-positive bacteria accounted for the highest proportion of Enterococcus faecium and Staphylococcus haemolyticus, while vancomycin was the most sensitive to carbapenem and amikacin. (3) the fungi were mainly Candida albicans and were sensitive to voleconazole.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 邵闖;薛建江;;碳青霉烯類耐藥肺炎克雷伯菌耐藥機(jī)制的研究進(jìn)展[J];現(xiàn)代醫(yī)藥衛(wèi)生;2016年20期

2 王宇;趙英;張峰;呂謙;鄭永綿;王智;張玉華;史憲杰;;腹部外科術(shù)后患者腹腔感染的病原菌分布及耐藥性分析[J];中華醫(yī)院感染學(xué)雜志;2016年15期

3 李秀軍;喬建文;畢永輝;耿建利;李文曉;白亮;;肝膽系統(tǒng)惡性腫瘤患者術(shù)后醫(yī)院感染及其危險(xiǎn)因素[J];中國(guó)感染控制雜志;2016年07期

4 艾葉青;張誠(chéng)華;劉卉芳;;原發(fā)性肝癌患者術(shù)后并發(fā)肺部感染的危險(xiǎn)因素分析[J];臨床肝膽病雜志;2016年07期

5 盧玲玲;鄭國(guó)軍;涂斐佩;吳海鷗;;大腸埃希菌對(duì)碳青霉烯類抗生素的耐藥機(jī)制研究[J];中國(guó)抗生素雜志;2016年04期

6 楊剛;尹寧;;革蘭陰性桿菌對(duì)碳青霉烯類藥物耐藥機(jī)制研究進(jìn)展[J];國(guó)際檢驗(yàn)醫(yī)學(xué)雜志;2016年02期

7 Wanqing Chen;;Cancer statistics: updated cancer burden in China[J];Chinese Journal of Cancer Research;2015年01期

8 劉婧嫻;俞靜;劉瑛;;產(chǎn)碳青霉烯酶肺炎克雷伯菌的耐藥基因及流行病學(xué)研究進(jìn)展[J];中國(guó)感染與化療雜志;2015年01期

9 聶署萍;陸學(xué)東;;碳青霉烯類抗生素耐藥及治療挑戰(zhàn)[J];傳染病信息;2014年03期

10 陳梅先;元云飛;陳盈;黃佳燕;吳劍輝;;肝膽外科手術(shù)患者醫(yī)院感染的相關(guān)因素分析[J];中華醫(yī)院感染學(xué)雜志;2014年01期

，

本文編號(hào)：2373312