Kong Qinxiang, Hu Lifen, Zhou Zhongsong, Shen Jilu, Xu Xihai, Ye Ying, Zhang Zhaoru, Li Jiabin
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2016 Mar;28(3):211-6.
To investigate the profile and antibiotic resistance of bacteria in patients with ascites infection in intensive care unit (ICU) patients in order to provide a reference for rational clinical use of antibiotics.
A retrospective analysis was conducted. The bacteria isolated from ascetic fluid patients admitted from January 1st, 2004 to October 31st, 2015 to ICU of the First Affiliated Hospital of Anhui Medical University were identified, and their susceptibility to antibiotics was analyzed. Patients, who were admitted from January 1st, 2004 to December 31st, 2009 were assigned to group A, and patients admitted afterwards were assigned to group B.
A total of 637 specimens of ascetic fluid were examined, with 185 positive culture (29.0%) during the 12 years, and 203 strains of bacteria were found. Among them 126 strains (62.1%) of gram-negative bacteria (G-), 54 (26.6%) of gram-positive bacteria (G+) and 23 (11.3%) strains of fungi were found. Compared the result of group B with that of group A, the proportion of G- bacteria was increased [71.2% (99/139) vs. 44.2% (27/64)], and that of G+ decreased [17.3% (24/139) vs. 46.9% (30/64)] in group B. The difference was statistically significant (χ2 = 20.34, P = 0.001). The main pathogenic bacteria were G-, and Enterobacteriaceae was the most common pathogenic bacteria in intra-abdominal infection of ICU patients. The isolation rate of Escherichia coli and Klebsiella pneumoniae(35.7%, 10.3%) ranked in the first and third in G- bacteria, respectively. The resistant rate of Escherichia coli against penicillin and third generation cephalosporin were > 95.0% and > 73.3%, and it showed a sensitive rate of 70% to β-lactam/inhibitor, amikacin and minocycline, and a higher sensitivity to carbapenems and tigecycline (11.1%, 0). Forty-eight strains of non-fermentation bacteria were found with a rate of 23.7%. The positive rates of Acinetobacter baumannii in groups A and B were 7.8% (5/64) and 23.7% (33/139), respectively, and they ranked first among non-fermentation bacteria. Twenty strains (62.5%) multidrug-resistant Acinetobacter baumannii were found. Acinetobacter baumannii showed a resistance rate of 84.6% to cefoperazone/sulbactam, 35.3% to minocycline, and 53.3% to tigecycline. Candida albicans was the most commonly isolated fungus in intra-abdominal infections (87.5%). No strains resistant to common antifungal drugs were isolated.
G- bacteria was the main pathogen in intra-abdominal infection in patients with ascites. Non-fermenters showed an increasing trend of producing infection, and the proportion of multidrug-resistant Acinetobacter baumannii infection increased year by year, and more attention should be taken by attending doctors.
调查重症监护病房（ICU）腹水感染患者的细菌谱及抗生素耐药情况，为临床合理使用抗生素提供参考。
进行回顾性分析。对2004年1月1日至2015年10月31日安徽医科大学第一附属医院ICU收治的腹水患者分离出的细菌进行鉴定，并分析其对抗生素的敏感性。将2004年1月1日至2009年12月31日收治的患者分为A组，之后收治的患者分为B组。
共检查637份腹水标本，12年间185份培养阳性（29.0%），共分离出203株细菌。其中革兰阴性菌（G-）126株（62.1%），革兰阳性菌（G+）54株（26.6%），真菌23株（11.3%）。B组与A组比较，B组G-菌比例升高[71.2%（99/139）比44.2%（27/64）]，G+菌比例降低[17.3%（24/139）比46.9%（30/64）]，差异有统计学意义（χ2 = 20.34，P = 0.001）。主要病原菌为G-菌，肠杆菌科是ICU患者腹腔内感染最常见的病原菌。大肠埃希菌和肺炎克雷伯菌的分离率在G-菌中分别居第一和第三位（35.7%，10.3%）。大肠埃希菌对青霉素和第三代头孢菌素的耐药率均>95.0%，对β-内酰胺/酶抑制剂、阿米卡星和米诺环素的敏感率为70%，对碳青霉烯类和替加环素的敏感性较高（11.1%，0）。发现48株非发酵菌，占比23.7%。鲍曼不动杆菌在A、B组的阳性率分别为7.8%（5/64）和23.7%（33/139），在非发酵菌中居首位，并发现20株（62.5%）多重耐药鲍曼不动杆菌。鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率为84.6%，对米诺环素为35.3%，对替加环素为53.3%。白色念珠菌是腹腔内感染最常见分离出的真菌（87.5%），未分离出对常用抗真菌药耐药的菌株。
G-菌是腹水患者腹腔内感染的主要病原菌。非发酵菌引起感染呈上升趋势，多重耐药鲍曼不动杆菌感染比例逐年增加，应引起临床医生更多关注。
