Didbaridze T, Saginashvili L, Akhmeteli L, Iremashvili B, Gogokhia N
The First University Clinic, Tbilisi State Medical University, Tbilisi, Georgia.
Georgian Med News. 2016 Sep(258):47-49.
This study provides a contemporary epidemiology of aspirates taken during surgery from the abdominal cavity among patients with bacterial peritonitis to identify the isolates and study their sensitivity to antibiotics. Our bacteriology investigations included isolation of poor cultures, and detection of microbes was conducted using a rapid identification system (API20E, API Staph, API Strep, API Ana, BioMerieux). Rapid tests for detection of oxidase and catalase activity were also used. Susceptibility of microorganisms to antibiotics was defined by the disc-diffusion method using standard discs (EUCAST guidelines 2015) according to Clinical Laboratory Standard Institute (CLSI) protocols (ATB strips: ATB G, ATB Staph, ATBANA, ATBPse, ATBStrep. BioMerieux). The recovery rate from the clinical samples was good, likely because our protocol immediately inoculated study material into the thioglycollate broth which is an appropriate medium both for aerobic and anaerobic bacteria. Among the 36 patients with monomicrobial growth by bacteriological investigation, Gram-negative bacteria prevailed; Escherichia coli was recovered in 14 patients and Enterobacter cloacae in 9 patients. Among the Gram-positive bacteria, D-group Streptococci were prevalent, Enterococcus faecalis was found in six patients, Staphylococcus aureus in three patients, Candida albicans in two patients. In one patient, we observed dual colonization of two Gram-negative anaerobes Bacteroides fragilis and Fusobacterium spp. Polymicrobial growth was evident in three cases in the following combinations: Candida albicans and Escherichia coli, Enterobacter cloacae and Candida albicans, Escherichia coli and Bacteroides fragilis. Antibiotic susceptibility testing indicated that 12% of Gram-negative bacteria were resistant to quinolones and 19% to third-generation cephalosporins. No evidence of methicillin-resistant Staphylococcus aureus was found in Gram-positive specimens. The timely identification of microbes and administration of appropriate therapy based on antibiotic sensitivity profiles is important to optimizing clinical outcomes in bacterial peritonitis.
本研究提供了细菌性腹膜炎患者手术期间腹腔吸出物的当代流行病学情况，以鉴定分离菌并研究其对抗生素的敏感性。我们的细菌学调查包括分离培养不佳的菌株，并使用快速鉴定系统（API20E、API Staph、API Strep、API Ana，生物梅里埃公司）进行微生物检测。还使用了检测氧化酶和过氧化氢酶活性的快速试验。根据临床实验室标准协会（CLSI）方案（ATB试纸条：ATB G、ATB Staph、ATBANA、ATBPse、ATBStrep，生物梅里埃公司），采用标准试纸条的纸片扩散法（依据2015年欧洲抗菌药物敏感性试验委员会指南）确定微生物对抗生素的敏感性。临床样本的回收率良好，这可能是因为我们的方案将研究材料立即接种到硫乙醇酸盐肉汤中，该肉汤是适合需氧菌和厌氧菌生长的培养基。在细菌学调查中，36例为单一微生物生长的患者中，革兰氏阴性菌占优势；14例患者分离出大肠杆菌，9例患者分离出阴沟肠杆菌。在革兰氏阳性菌中，D群链球菌占优势，6例患者发现粪肠球菌，3例患者发现金黄色葡萄球菌，2例患者发现白色念珠菌。在1例患者中，我们观察到两种革兰氏阴性厌氧菌脆弱拟杆菌和梭杆菌属的双重定植。在3例病例中，以下组合显示明显的多微生物生长：白色念珠菌和大肠杆菌、阴沟肠杆菌和白色念珠菌、大肠杆菌和脆弱拟杆菌。抗生素敏感性测试表明，12%的革兰氏阴性菌对喹诺酮类耐药，19%对第三代头孢菌素耐药。在革兰氏阳性样本中未发现耐甲氧西林金黄色葡萄球菌的证据。及时鉴定微生物并根据抗生素敏感性谱给予适当治疗对于优化细菌性腹膜炎的临床结局很重要。
