腹部创伤并严重腹腔感染患者腹腔脓液细菌学及耐药分析
张少一 李幼生 王剑 虞文魁 李宁 黎介寿
【摘要】目的分析腹部创伤并严重腹腔感染患者的腹腔脓液细菌菌群分布及体外药物敏感
情况。方法2001年1月至2012年5月南京军区南京总医院全军普通外科研究所收治的腹部创伤
并发严重腹腔感染病例4l例，获得腹腔脓液标本共123份，回顾性分析微生物实验室菌群及药敏结
果，输入WHONET 5．4软件进行耐药性分析。结果41例患者腹腔脓液标本共分离出297株菌，平
均(7．2±2．3)株。革兰阳性细菌占44．1％(131／297)，革兰阴性细菌占55．2％(164／297)，真菌占
0．7％(2／297)。分离率前5位的细菌依次为大肠埃希菌(72株，24．2％)、金黄色葡萄球菌(66株，
22．2％)、肺炎克雷伯菌(34株，11．4％)、粪肠球菌(28株，9．4％)和铜绿假单胞菌(2l株，7．1％)。
大肠埃希菌对头孢哌酮和亚胺培南的敏感率较高，均超过90％，分别为91％和98％。革兰阳性球菌
对替考拉宁和利奈唑胺的敏感率均为100％，金黄色葡萄球菌对万古霉素敏感率为100％。肺炎克雷
伯菌对亚胺培南的敏感率为100％、对阿米卡星的敏感率为79％。铜绿假单胞菌对环丙沙星敏感率
最高(90％)。结论腹部创伤并严重腹腔感染患者腹腔感染菌尽管以革兰阴性菌为主，但革兰阳性
菌，特别是金黄色葡萄球菌感染比例也较高；头孢哌酮、环丙沙星、亚胺培南、万古霉素、替考拉宁、利
奈唑胺具有较高的抗菌活性。
【关键词】腹部损伤；细菌学；脓毒症；休克，脓毒性；严重腹腔感染
Bacteriological spectrum and drug susceptibility of pus from severe intra-abdominal infected patients
诚th abdominal trauma zHANG Shao—yi．LI You—sheng，WANG Jian．YU Wen—kut，LI N讥g．
u J拒一shota Department of General Surgery，School ofMedicine．Nnnjtng University；General PLA Hospital of
Nanjing Military Command，Nn蟛ng 210002，China
Corresponding author：LI You-sheng．Emaif：liys@medmaiL
【Abstract】objective To retrospectively analyze the bacteriological spectrum and drug
susceptibility of pus flora from abdominal traumatic patients with severe intra．abdominal infection．Methods
A total of 41 severe intra．abdominal infected patients with abdominal trauma were recruited to collect 123
abdominal pus specimens．And the results of laboratory microbiology and drug sensitivity were analyzed with
the WHONET 5．4 software．Results A total of 297 strains of bacteria were isolated at(7．2±2．3)strains
for each patient．Gram．positive bacteria accounted for 44．1％(1 3 1／297)，Gram．negative bacteria 55．2％
(1 64／297)and fungi 0．7％(2／297)．The top five isolates were Escherichia coli，Staphylococcus aureus，
Klebsiella pneumonia，Enterococcus[aecal厶and Pseudomonas aeruginosa．Those antibiotics highly sensitive
(>90％)to Escherichia coli included cefoperzone(9 1％)，imipenem(98％)；highly sensitive to Grampositive
COCCi included teicoplanin(100％)and linezolid(100％)．Staphylococcus oure泌was 100％
sensitive to vancomycin．The agents with a high susceptibility to Klebsiella pneumonia included imipenem
(1 00％)and amikacin(79％)．Ciprofloxacin(90％)had the highest sensitivity to Pseudomonas
aeruginosa．Conclusions The predominant bacteria of causing severe intra—abdominal infection of traumatic
patients
is Gram—negative bacteria，but the infection of Gram-positive bacteria，especially the ratio of
Staphylococcus aureus infection is also comparatively high．Cefoperazone，ciprofloxacin，imipenem，
vancomycin．teicoplanin and linezolid have higherly antibacterial activity．
【Key words】Abdominal injuries； Bacteriology； Sepsis； Shock，septic； Severe intra—
abdominal jnfection
DOI：10．3760／cma．j．issn．0376—2491．2013．32．009
作者单位：210002南京大学医学院临床学院南京军区南京总医院全军普通外科研究所
通信作者：李幼生，Email：liys@medmail．
发表于 2014-3-12 11:06
发表于 2014-3-12 11:31