重症急性胰腺炎患者并发感染的影响因素与病原菌及耐药性分析
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摘要
目的 探究重症急性胰腺炎患者并发感染的影响因素与病原菌及其耐药性。方法 选取2013年6月-2017年6月于医院接受治疗的120例重症急性胰腺炎患者为研究对象,分析其并发感染的临床特征、感染的病原菌及耐药性。结果 重症急性胰腺炎感染率为45.83%(55/120)。共培养分离病原菌100株,其中革兰阴性菌67株占67.00%,以鲍氏不动杆菌和大肠埃希菌为主;革兰阳性菌16株占16.00%,以金黄色葡萄球菌为主;真菌17株占17.00%。主要病原菌对多种抗菌药物存在不同程度的耐药性,主要革兰阳性菌对万古霉素和磺胺甲噁唑/甲氧苄啶敏较感;鲍氏不动杆菌对多数抗菌药物耐药率>50%,仅对亚胺培南耐药率较低为47.37%(9/19);大肠埃希菌对亚胺培南、丁胺卡那霉素和头孢西丁较敏感。APACHEⅡ、胰腺外部感染、多器官功能衰竭、糖尿病和机械通气时间均是影响重症急性胰腺炎患者感染的影响因素(P<0.05)。结论 重症急性胰腺炎患者并发感染受多方面因素影响。革兰阴性菌是重症急性胰腺炎患者并发感染的主要菌种,具有高度耐药性,对多种抗菌药物的敏感度普遍偏低。
OBJECTIVE To explore the influencing factors for, pathogens and drug resistance of and observe the pathogens and their drug resistance. METHODS Totally 120 patients with severe acute pancreatitis who were treated in our hospital from Jun. 2013 to Jun. 2017 were selected as subjects. The clinical features, pathogens and drug resistance of concurrent infection in patients with severe acute pancreatitis were analyzed. RESULTS The infection rate of severe acute pancreatitis was 45.83%(55/120). A total of 100 strains of pathogens were isolated, of which 67 strains were gram-negative bacteria, accounting for 67.00%, mainly Acinetobacter baumannii and Escherichia coli; 16 strains were gram-positive bacteria, mainly Staphylococcus aureus; 17 strains were fungi, accounting for 17.00%. The main pathogens were resistant to many kinds of antimicrobial agents to varying degrees. The main gram-positive bacteria were sensitive to vancomycin and sulfamethoxazole/trimethoprim. The resistance rate of Acinetobacter baumannii to most antimicrobial agents was more than 50%, and the resistance rate to imipenem was lower than 47.37%(9/19); Escherichia coli was sensitive to imipenem, amikacin and cefoxitin. APACHE II, external pancreatic infection, multiple organ failure, diabetes mellitus and mechanical ventilation time were the influencing factors of infection in patients with severe acute pancreatitis(P<0.05). CONCLUSION Concurrent infections in patients with severe acute pancreatitis are affected by many factors. Gram-negative bacteria are the main strains of concurrent infection in patients with severe acute pancreatitis. Gram-negative bacteria are highly drug resistant, and their sensitivity to various antibacterial drugs is generally low.
OBJECTIVE To explore the influencing factors for, pathogens and drug resistance of and observe the pathogens and their drug resistance. METHODS Totally 120 patients with severe acute pancreatitis who were treated in our hospital from Jun. 2013 to Jun. 2017 were selected as subjects. The clinical features, pathogens and drug resistance of concurrent infection in patients with severe acute pancreatitis were analyzed. RESULTS The infection rate of severe acute pancreatitis was 45.83%(55/120). A total of 100 strains of pathogens were isolated, of which 67 strains were gram-negative bacteria, accounting for 67.00%, mainly Acinetobacter baumannii and Escherichia coli; 16 strains were gram-positive bacteria, mainly Staphylococcus aureus; 17 strains were fungi, accounting for 17.00%. The main pathogens were resistant to many kinds of antimicrobial agents to varying degrees. The main gram-positive bacteria were sensitive to vancomycin and sulfamethoxazole/trimethoprim. The resistance rate of Acinetobacter baumannii to most antimicrobial agents was more than 50%, and the resistance rate to imipenem was lower than 47.37%(9/19); Escherichia coli was sensitive to imipenem, amikacin and cefoxitin. APACHE II, external pancreatic infection, multiple organ failure, diabetes mellitus and mechanical ventilation time were the influencing factors of infection in patients with severe acute pancreatitis(P<0.05). CONCLUSION Concurrent infections in patients with severe acute pancreatitis are affected by many factors. Gram-negative bacteria are the main strains of concurrent infection in patients with severe acute pancreatitis. Gram-negative bacteria are highly drug resistant, and their sensitivity to various antibacterial drugs is generally low.
引文
[1] 杨先铭.重症急性胰腺炎患者并发感染的临床特征及影响因素研究[J].中国现代普通外科进展,2017,20(6):502-504.
[2] 罗少媚,钟智,叶营,等.重症急性胰腺炎并发感染患者的免疫状况研究[J].河北医学,2015,(7):1082-1085.
[3] 聂胜利,吴伍林,王蓓蓓,等.降钙素原检测对重症急性胰腺炎并发感染的诊断价值分析[J].中华普外科手术学杂志(电子版),2017,11(2):162-164.
[4] 唐春,赵晓璠,何琴,等.重症急性胰腺炎病人外周血细菌DNA分子谱图[J].肠外与肠内营养,2018,25(1):46-51.
[5] 王琼,杨晓钟,戴伟杰,等.重症急性胰腺炎患者腹腔感染病原菌分布与危险因素分析[J].中华医院感染学杂志,2015,25(23):5346-5348.
[6] 李晓芳,李萍,郭卫卫,等.重症急性胰腺炎患者并发感染的临床特征及相关危险因素分析[J].现代生物医学进展,2016,16(19):3700-3702.
[7] 张明刚,段军,陶永康,等.重症急性胰腺炎患者真菌感染特征分析[J].中华医院感染学杂志,2016,26(16):3760-3762.
[8] 中国中西医结合学会普通外科专业委员会.重症急性胰腺炎中西医结合诊治常规(草案)[J].中国危重病急救医学,2007,19(8):448-451.
[9] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[10] 何馥倩,黄宗文,郭佳,等.重症急性胰腺炎并发感染的菌谱和耐药性[J].世界华人消化杂志,2007,15(32):3418-3422.
[11] 陈东,石晓卉,肖东,等.重症胰腺炎并发感染危险因素研究[J].中国医学前沿杂志(电子版),2017,9(2):133-136.
[12] 李斌杰,赵二鹏,郑云,等.重症急性胰腺炎并发胰腺感染的危险因素分析及防治措施[J].中国中西医结合外科杂志,2014,(2):111-113.
[13] 陈宏斌,王辉.2017年CLSI M100-S27主要更新内容解读[J].中华检验医学杂志,2017,40(4):238-241.
[14] 张翔,陈洪娇,王雅纯,等.重症急性胰腺炎后期感染性胰腺坏死危险因素的临床研究[J].中国现代医学杂志,2016,26(4):115-118.
[15] Zhou F,Wang C,Xiong J,et al.Experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis by TAE[J].J Huazhong Univ Sci Technolog Med Sci,2005,25(2):182-184.
[16] Guo J,Huang W,Yang XN,et al.Short-term continuous high-volume hemofiltration on clinical outcomes of severe acutepancreatitis[J].Pancreas,2014,43(2):250-254.
[17] Garib G,Hughey LC,Elmets CA,et al.Atypical presentation of exophytic herpes simplex virus type 2 with concurrent cytomegalovirusinfection:a significant pitfall in diagnosis[J].Am J Dermatopathol,2013,35(3):371-376.
[18] Kumar S,Kumar PS,Kaur G,et al.Rare concurrent infection with scrub typhus,dengue and malaria in a young female[J].J Vector Borne Dis,2014,51(1):71-72.
[19] Whitworth JR,Mack CL,O'Connor JA,et al.Acute hepatitis and liver failure associated with influenza A infection in children[J].J Pediatr Gastroenterol Nutr,2006,43(4):536-538.
[20] Liu R,Qi H,Wang J,et al.Ulinastatin activates the renin-angiotensin system to ameliorate the pathophysiology of severeacute pancreatitis[J].J Gastroenterol Hepatol,2014,29(6):1328-1237.
[21] Zhang SY,Liang ZY,Yu WQ,et al.Early enteral nutrition with polymeric feeds was associated with chylous ascites in patients with severe acute pancreatitis[J].Pancreas,2014,43(4):553-558.
[22] Nikkola J,Rinta-Kiikka I,Raty S,et al.Pancreatic morphological changes in long-term follow-up after initial episode of acute alcoholicpancreatitis[J].J Gastrointest Surg,2014,18(1):164-170.
[23] Ulagendra Perumal S,Pillai SA,Perumal S,et al.Outcome of video-assisted translumbar retroperitoneal necrosectomy and closed lavage for severe necrotizing pancreatitis[J].ANZ J Surg,2014,84(4):270-274.
[24] Feyles F,Mussa A,Peiretti V,et al.Iatrogenic acute pancreatitis due to hypercalcemia in a child with pseudohypoparathyroidism[J].J Pediatr Endocrinol Metab,2014,27(1-2):149-152.
[25] Jacob TG,Raghav R,Kumar A,et al.Duration of injury correlates with necrosis in caerulein-induced experimental acute pancreatitis:implications for pathophysiology[J].Int J Exp Pathol,2014,95(3):199-208.
[26] Afghani E,Sinha A,Singh VK.An overview of the diagnosis and management of nutrition in chronic pancreatitis[J].Nutr Clin Pract,2014,29(3):295-311.
[2] 罗少媚,钟智,叶营,等.重症急性胰腺炎并发感染患者的免疫状况研究[J].河北医学,2015,(7):1082-1085.
[3] 聂胜利,吴伍林,王蓓蓓,等.降钙素原检测对重症急性胰腺炎并发感染的诊断价值分析[J].中华普外科手术学杂志(电子版),2017,11(2):162-164.
[4] 唐春,赵晓璠,何琴,等.重症急性胰腺炎病人外周血细菌DNA分子谱图[J].肠外与肠内营养,2018,25(1):46-51.
[5] 王琼,杨晓钟,戴伟杰,等.重症急性胰腺炎患者腹腔感染病原菌分布与危险因素分析[J].中华医院感染学杂志,2015,25(23):5346-5348.
[6] 李晓芳,李萍,郭卫卫,等.重症急性胰腺炎患者并发感染的临床特征及相关危险因素分析[J].现代生物医学进展,2016,16(19):3700-3702.
[7] 张明刚,段军,陶永康,等.重症急性胰腺炎患者真菌感染特征分析[J].中华医院感染学杂志,2016,26(16):3760-3762.
[8] 中国中西医结合学会普通外科专业委员会.重症急性胰腺炎中西医结合诊治常规(草案)[J].中国危重病急救医学,2007,19(8):448-451.
[9] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[10] 何馥倩,黄宗文,郭佳,等.重症急性胰腺炎并发感染的菌谱和耐药性[J].世界华人消化杂志,2007,15(32):3418-3422.
[11] 陈东,石晓卉,肖东,等.重症胰腺炎并发感染危险因素研究[J].中国医学前沿杂志(电子版),2017,9(2):133-136.
[12] 李斌杰,赵二鹏,郑云,等.重症急性胰腺炎并发胰腺感染的危险因素分析及防治措施[J].中国中西医结合外科杂志,2014,(2):111-113.
[13] 陈宏斌,王辉.2017年CLSI M100-S27主要更新内容解读[J].中华检验医学杂志,2017,40(4):238-241.
[14] 张翔,陈洪娇,王雅纯,等.重症急性胰腺炎后期感染性胰腺坏死危险因素的临床研究[J].中国现代医学杂志,2016,26(4):115-118.
[15] Zhou F,Wang C,Xiong J,et al.Experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis by TAE[J].J Huazhong Univ Sci Technolog Med Sci,2005,25(2):182-184.
[16] Guo J,Huang W,Yang XN,et al.Short-term continuous high-volume hemofiltration on clinical outcomes of severe acutepancreatitis[J].Pancreas,2014,43(2):250-254.
[17] Garib G,Hughey LC,Elmets CA,et al.Atypical presentation of exophytic herpes simplex virus type 2 with concurrent cytomegalovirusinfection:a significant pitfall in diagnosis[J].Am J Dermatopathol,2013,35(3):371-376.
[18] Kumar S,Kumar PS,Kaur G,et al.Rare concurrent infection with scrub typhus,dengue and malaria in a young female[J].J Vector Borne Dis,2014,51(1):71-72.
[19] Whitworth JR,Mack CL,O'Connor JA,et al.Acute hepatitis and liver failure associated with influenza A infection in children[J].J Pediatr Gastroenterol Nutr,2006,43(4):536-538.
[20] Liu R,Qi H,Wang J,et al.Ulinastatin activates the renin-angiotensin system to ameliorate the pathophysiology of severeacute pancreatitis[J].J Gastroenterol Hepatol,2014,29(6):1328-1237.
[21] Zhang SY,Liang ZY,Yu WQ,et al.Early enteral nutrition with polymeric feeds was associated with chylous ascites in patients with severe acute pancreatitis[J].Pancreas,2014,43(4):553-558.
[22] Nikkola J,Rinta-Kiikka I,Raty S,et al.Pancreatic morphological changes in long-term follow-up after initial episode of acute alcoholicpancreatitis[J].J Gastrointest Surg,2014,18(1):164-170.
[23] Ulagendra Perumal S,Pillai SA,Perumal S,et al.Outcome of video-assisted translumbar retroperitoneal necrosectomy and closed lavage for severe necrotizing pancreatitis[J].ANZ J Surg,2014,84(4):270-274.
[24] Feyles F,Mussa A,Peiretti V,et al.Iatrogenic acute pancreatitis due to hypercalcemia in a child with pseudohypoparathyroidism[J].J Pediatr Endocrinol Metab,2014,27(1-2):149-152.
[25] Jacob TG,Raghav R,Kumar A,et al.Duration of injury correlates with necrosis in caerulein-induced experimental acute pancreatitis:implications for pathophysiology[J].Int J Exp Pathol,2014,95(3):199-208.
[26] Afghani E,Sinha A,Singh VK.An overview of the diagnosis and management of nutrition in chronic pancreatitis[J].Nutr Clin Pract,2014,29(3):295-311.
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