Chabok Abbas, Tärnberg Maria, Smedh Kenneth, Påhlman Lars, Nilsson Lennart E, Lindberg Christian, Hanberger Håkan
Department of Surgery, Uppsala University, Central Hospital, Västerås, Sweden.
Scand J Gastroenterol. 2010 Oct;45(10):1203-10. doi: 10.3109/00365521.2010.495417.
Antibiotic resistance is increasing worldwide. The aims of the current study were to determine the fecal carriage of antibiotic-resistant bacteria and antibiotic treatment in surgical patients admitted to hospital due to acute intra-abdominal infections.
Eight Swedish surgical units participated in this prospective multicenter investigation. Rectal swabs were obtained on admission to hospital. Cultures were performed on chromogenic agar and antibiotic susceptibility testing was performed using the disk diffusion method. Extended-spectrum beta-lactamase (ESBL)-phenotype was confirmed by Etest.
Rectal samples were obtained and analyzed from 208 patients with intra-abdominal surgical infections. Surgery was performed in 134 patients (65%). Cephalosporins were the most frequently used empirical antibiotic therapy. The highest rates of resistance among Enterobacteriaceae were detected for ampicillin (54%), tetracycline (26%), cefuroxime (26%) and trimethoprim-sulfamethoxazole (20%). The prevalence of decreased susceptibility (I + R) for the other antibiotics tested was for ciprofloxacin 20%, piperacillin-tazobactam 17%, cefotaxime 14%, ertapenem 12%, gentamicin 3% and imipenem 0%. ESBL-producing Enterobacteriaceae were found in samples from 10 patients (5%). Three patients had five E. coli isolates producing AmpC enzymes.
This study shows a high rate of resistance among Enterobacteriaceae against antibiotics which are commonly used in Sweden and should have implications for the future choice of antibiotics for surgical patients.
抗生素耐药性在全球范围内日益增加。本研究的目的是确定因急性腹腔内感染入院的外科患者中抗生素耐药菌的粪便携带情况及抗生素治疗情况。
八个瑞典外科单位参与了这项前瞻性多中心研究。入院时采集直肠拭子。在显色琼脂上进行培养，并使用纸片扩散法进行抗生素敏感性测试。超广谱β-内酰胺酶（ESBL）表型通过Etest确认。
从208例腹腔外科感染患者中获取并分析了直肠样本。134例患者（65%）接受了手术。头孢菌素是最常用的经验性抗生素治疗药物。在肠杆菌科中，氨苄西林的耐药率最高（54%），其次是四环素（26%）、头孢呋辛（26%）和甲氧苄啶-磺胺甲恶唑（20%）。所测试的其他抗生素的敏感性降低（I+R）患病率分别为：环丙沙星20%、哌拉西林-他唑巴坦17%、头孢噻肟14%、厄他培南12%、庆大霉素3%和亚胺培南0%。在10例患者（5%）的样本中发现了产ESBL的肠杆菌科细菌。3例患者有5株产AmpC酶的大肠杆菌分离株。
本研究表明，瑞典常用的抗生素对肠杆菌科细菌的耐药率很高，这对未来外科患者抗生素的选择具有启示意义。
