宋玲莉

[摘要] 目的 分析重癥急性胰腺炎繼發(fā)感染的病原菌分布及臨床特點(diǎn)。方法 隨機(jī)選擇該院自2018年1月—2019年10月收治的70例重癥急性胰腺炎繼發(fā)感染患者作為研究對象，取患者氣管深部痰液作為檢驗(yàn)標(biāo)本，行細(xì)菌培養(yǎng)，再采用全自動微生物分析系統(tǒng)檢驗(yàn)其病原菌分布情況，然后，根據(jù)病原菌檢出情況開展藥敏試驗(yàn)，總結(jié)其常見致病菌的耐藥情況。結(jié)果 70例患者共分離培養(yǎng)出75株病原菌株，其中，20株為革蘭陽性菌（包含9株葡萄球菌、7株腸球菌、4株鏈球菌），占比26.67%，41株為革蘭陰性菌（包含12株鮑曼溶血不動桿菌、10株肺炎克雷伯氏菌、8株大腸埃希菌、6株銅綠假單胞菌、5株陰溝腸桿菌），占比54.67%，14株為真菌（包含4株光滑念珠菌、8株白色念珠菌、2株熱帶念珠菌），占比18.67%，革蘭陰性菌占比>革蘭陽性菌占比>真菌占比，各類型病原菌占比對比差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;不同革蘭陽性菌及革蘭陰性菌的耐藥率均有一定的差異，其中，革蘭陽性菌對萬古霉素的耐藥率均較低;革蘭陰性菌對舒普深、替加環(huán)素的耐藥率均較低。結(jié)論 重癥急性胰腺炎繼發(fā)感染的病原菌以革蘭陰性菌為主，且不同致病菌的耐藥性具有一定差異，為提高患者抗感染治療效果和避免其出現(xiàn)耐藥性，就需臨床盡早對患者行細(xì)菌培養(yǎng)檢測，以明確其病原菌分布情況，再指導(dǎo)臨床采用合理的抗菌藥物對患者進(jìn)行治療。

[關(guān)鍵詞] 重癥急性胰腺炎;繼發(fā)感染;病原菌分布;臨床特點(diǎn)

[中圖分類號] R446? ? ? ? ? [文獻(xiàn)標(biāo)識碼] A? ? ? ? ? [文章編號] 1674-0742（2020）06（a）-0196-03

Distribution and Clinical Characteristics of Pathogens Secondary to Severe Acute Pancreatitis

SONG Ling-li

Department of Gastroenterology， Xiushan County People's Hospital， Chongqing， 409900 China

[Abstract] Objective To analyze the distribution and clinical characteristics of pathogens secondary to severe acute pancreatitis. Methods A total of 70 patients with randomly severe acute pancreatitis secondary infections who were treated in the hospital from January 2018 to October 2019 were selected as the research subjects. Patients' deep trachea sputum was used as a test specimen for bacterial culture， and then fully automatic microorganisms were used. The analysis system examines the distribution of pathogenic bacteria， and then conducts drug sensitivity tests based on the detection of pathogenic bacteria to summarize the drug resistance of common pathogenic bacteria. Results A total of 75 pathogenic strains were isolated and cultured in 70 patients. Among them， 20 strains were Gram-positive bacteria （including 9 strains of Staphylococcus， 7 Enterococcus， 4 Streptococcus）， accounting for 26.67%， and 41 strains were leather. Blue negative bacteria （including 12 strains of A. baumannii， 10 strains of Klebsiella pneumoniae， 8 strains of Escherichia coli， 6 strains of Pseudomonas aeruginosa， 5 strains of Enterobacter cloacae）， accounting for 54.67%， 14 strains were fungi （including 4 strains of Candida glabrata， 8 strains of Candida albicans， and 2 strains of Candida tropicalis）， accounting for 18.67%， Gram-negative bacteria proportion> Gram-positive bacteria proportion> Fungi proportion， each type proportion of pathogenic bacteria was statistically significant （P<0.05）; the resistance rates of different Gram-positive bacteria and Gram-negative bacteria were different， and among them， the resistance rate of Gram-positive bacteria to vancomycin was higher than that of vancomycin; Gram-negative bacteria have lower resistance to Shupushen and Tigecycline. Conclusion Gram-negative bacteria are the main pathogens in secondary infection of severe acute pancreatitis， and the drug resistance of different pathogenic bacteria is different. To improve the anti-infective treatment effect and avoid drug resistance， it is necessary to clinically Bacterial culture tests should be performed on patients as early as possible to clarify the distribution of pathogenic bacteria， and then guide clinical treatment of patients with reasonable antibacterial drugs.

綜上所述，重癥急性胰腺炎繼發(fā)感染的病原菌以革蘭陰性菌為主，且不同致病菌的耐藥性具有一定差異，為提高患者抗感染治療效果和避免其出現(xiàn)耐藥性，就需臨床盡早對患者行細(xì)菌培養(yǎng)檢測，以明確其病原菌分布情況，再指導(dǎo)臨床采用合理的抗菌藥物對患者進(jìn)行治療。

[參考文獻(xiàn)]

[1]? 殷躍文.急性胰腺炎感染者免疫狀況、病原學(xué)分布及相關(guān)危險(xiǎn)因素分析[J].中國病原生物學(xué)雜志，2019，14（8）：948-951.

[2]? Koutroumpakis E，Slivka A，F(xiàn)urlan A，et al.Man-agement and outcomes of acute pancreatitis patients over the last decade：A US tertiar-center experience[J].Pancreatology，2017，17（1）：32-40.

[3]? 杜奕奇，李維勤，毛恩強(qiáng).中國急性胰腺炎多學(xué)科診治（MDT）共識意見（草案）[J].中國實(shí)用內(nèi)科雜 志，2015，（12）：1004-1010.

[4]? 周磊，劉蘇來，成偉.重癥急性胰腺炎繼發(fā)膿毒癥危險(xiǎn)因素分析[J].實(shí)用休克雜志：中英文，2018，2（4）：218-222.

[5]? MA H X，HE L，CAI SW，et al.Analysis of the spectrumand resistance of pathogen causing sepsis in patients with severe acute pancreatitis[J].Zhonghua Wai Ke Za Zhi，2017，55（5）：378-383.

[6]? 陳文海.重癥急性胰腺炎繼發(fā)胰腺感染的危險(xiǎn)因素和感染特點(diǎn)分析[J].河南外科學(xué)雜志，2016，22（4）：19-20.

[7]? 楊衛(wèi)軍，杜吉義，吳正陽，等.重癥急性胰腺炎患者繼發(fā)胰腺感染特點(diǎn)及危險(xiǎn)因素分析[J].中華醫(yī)院感染學(xué)雜志，2017， 27（19）：4453-4456.

[8]? 肖文艷，陳虎，曹利軍，等.重癥急性胰腺炎繼發(fā)感染的病原菌分布特點(diǎn)[J].肝膽外科雜志，2018，26（5）：348-351.

（收稿日期：2020-03-04）