Samuelsson Annika, Isaksson Barbro, Chabok Abbas, Jonasson Jon, Nilsson Lennart E, Eriksson Olle, Hanberger Håkan
Department of Infection Control, University Hospital Linköping, Linköping, Sweden.
Scand J Infect Dis. 2012 Nov;44(11):820-7. doi: 10.3109/00365548.2012.695455. Epub 2012 Jul 25.
An open observational study was performed to investigate changes in the rectal flora and antibiotic susceptibility among faecal bacteria in patients treated with antibiotics for acute intra-abdominal infection.
One hundred and forty patients with acute intra-abdominal infection requiring antibiotic treatment and hospitalization were included. Eight surgical units from the southern part of Sweden participated, between January 2006 and November 2007. Antibiotic treatments were according to local guidelines. Rectal swabs were obtained on admission (sample 1) and 2-14 days after the end of antibiotic treatment (sample 2). Aerobic bacteria and yeasts were analysed. The material was divided into 2 groups: 1 group with Enterobacteriaceae and 1 group with non-fermentative Gram-negative bacteria. The susceptibility to antibiotics in each group was compared between samples 1 and 2.
The main finding of this study on patients with severe intra-abdominal infections was a shift in the aerobic faecal flora following antibiotic treatment, from Escherichia coli to other more resistant Enterobacteriaceae, Enterococcus faecium, and yeasts. The susceptibility to cephalosporins and piperacillin-tazobactam decreased in Enterobacteriaceae.
Following antibiotic treatment, a shift in the aerobic rectal flora to species with intrinsic antibiotic resistance was observed. This indicates that the emergence of resistance is not due to new mutations, but rather to selection of more resistant species. This should be taken into account when designing treatments for secondary intra-abdominal infections.
开展一项开放性观察性研究，以调查因急性腹腔内感染接受抗生素治疗的患者直肠菌群及粪便细菌抗生素敏感性的变化。
纳入140例因急性腹腔内感染需要抗生素治疗并住院的患者。2006年1月至2007年11月期间，瑞典南部的8个外科单位参与了研究。抗生素治疗遵循当地指南。在入院时（样本1）及抗生素治疗结束后2 - 14天（样本2）采集直肠拭子。对需氧菌和酵母菌进行分析。样本分为两组：一组为肠杆菌科细菌，另一组为非发酵革兰阴性菌。比较样本1和样本2中每组对抗生素的敏感性。
本研究对重症腹腔内感染患者的主要发现是，抗生素治疗后需氧粪便菌群发生了变化，从大肠杆菌转变为其他耐药性更强的肠杆菌科细菌、粪肠球菌和酵母菌。肠杆菌科细菌对头孢菌素和哌拉西林 - 他唑巴坦的敏感性降低。
抗生素治疗后，观察到需氧直肠菌群向具有内在抗生素耐药性的菌种转变。这表明耐药性的出现并非由于新的突变，而是由于选择了耐药性更强的菌种。在设计继发性腹腔内感染的治疗方案时应考虑到这一点。
