759例急性阑尾炎患者阑尾组织细菌培养主要病原菌耐药性分析

目的分析急性阑尾炎患者术中阑尾组织细菌培养分离的主要病原菌及药敏试验结果,为临床合理用药提供参考。方法收集2014-2018年在武威市凉州医院接受阑尾切除术的759例急性阑尾炎患者术中阑尾组织标本,分离可疑菌落进行鉴定和药敏试验。观察细菌培养阳性结果,采用WHONET 5.6软件统计数据并分析。结果共分离细菌794株,其中革兰阴性(G^-)杆菌685株(占86.27%),以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌检出率最高,分别为69.14%、5.16%、2.64%;革兰阳性(G^+)球菌109株(占13.73%),以屎肠球菌和金黄色葡萄球菌多见,检出率分别为6.80%、2.02%。G^-杆菌对哌拉西林/他唑巴坦、头孢他啶、头孢西丁、阿米卡星敏感性较好,对美罗培南耐药率为0。G^+球菌对青霉素、红霉素耐药率较高,对万古霉素、利奈唑胺耐药率为0。结论武威地区急性阑尾炎患者以G^-杆菌感染为主,建议将哌拉西林/他唑巴坦作为控制G^-杆菌感染的首选药物。及时关注本地区细菌耐药变化趋势,有利于提高抗感染疗效,减少耐药菌产生。

Drug resistance analysis on main pathogens cultured in 759 cases of appendiceal tissue

Objective To analyze the main pathogens isolated from bacterial culture of intraoperative tissue in acute appendicitis patients and drug sensitive test results,and provide reference for clinical rational drug use.Methods The appendiceal samples in 759 patients with acute appendicitis undergoing appendectomy in Liangzhou Hospital of Wuwei City from 2014 to 2018 were collected.The suspicious colonies were isolated for identification and drug sensitivity test.The positive results of bacterial culture were observed,and WHONET 5.6 software was used to analyze the statistical data.Results Totally 794 strains of bacteria were isolated,of which 685 strains(86.27%)were Gram-negative(G^-),and the detection rates of Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae were the highest(69.14%,5.16%and 2.64%).Gram-positive(G^+)cocci were 109 strains(13.73%),Enterococcus faecium and Staphylococcus aureus were the most common,the detection rates were 6.80% and 2.02%,respectively.The sensitivity of G-bacilli to piperacillin/tazobactam,ceftazidime,cefoxitin and amikacin was better,and the resistance rate to meropenem was 0.The drug resistance rate of G+cocci to penicillin and erythromycin was high,and that to vancomycin and linezolid was 0.Conclusions Patients with acute appendicitis in Wuwei area were mainly infected by G-bacilli,it is suggested that piperacillin/tazobactam should be the first choice for control of G-bacilli infection.Timely attention to the change trend of bacterial drug resistance in this area could improve the anti infection effect and reduce the production of drug-resistant bacteria.