Abstract:

Shifting trends in bacteriology and antimicrobial resistance among gastrointestinal fistula patients        LIU Qin-jie，REN Jian-an，WU Xiu-wen，et al. Research Institute of General Surgery，Nanjing General Hospital, PLA, Nanjing 210002, china
Corresponding author：REN Jian-an，E-mail：Jiananr@gmail.com
Abstract    Objective    To determine the shifting trends in bacteriology and antimicrobial resistance of infectious specimens isolated from gastrointestinal (GI) fistula patients. Methods    The abdominal specimen of 502 cases of IAI admitted from 2018 to 2015 in Jinling Hospital of Nanjing Medical University was collected.  Results    A total of 874 intra-abdominal isolates were consecutively collected. Over the entire study period, most infections were caused by E. coli (216, 24.7%) and K. pneumonia (123, 14.1%). The proportion of E. coli resistant to imipenem increased from 14.3% in 2008-2011 to 25.9% in 2012-2015 (P=0.037). Imipenem resistance prevalence was higher in ESBL-negative bacteria than ESBL-positive bacteria for both E. coli and K. pneumonia (P< 0.001). In Enterococcus, significant increase in resistance to ampicillin (P=0.01) and moxifloxacin (P=0.02) over time were observed. In Staphylococcus and fungi, rates of antibiotic resistance did not significantly change over the study period. Conclusion    Gram-negative bacteria predominated as causative agents of intra-abdominal infections in GI fistula patients, and there was an increase in levels of resistance to certain antibiotics, particularly carbapenems. We need to monitor the antibiotic resistance extensively and dynamically.

Key words: gastrointestinal fistula, intra-abdominal infections, bacteriology, antibiotic

摘要：

目的    分析肠外瘘致腹腔感染病人腹腔穿刺液中病原菌分布及耐药率变化。方法    回顾性分析2008—2015年南京医科大学附属金陵医院收治的502例肠外瘘并发腹腔感染病人腹腔穿刺标本的细菌鉴定及药敏结果。对比分析早期组（2008—2011年）及近期组（2012—2015年）的细菌及其耐药变化。结果    502例肠外瘘病人腹腔标本共分离出病原菌874株，其中大肠埃希菌（216株，24.7%），肺炎克雷伯杆菌（123株，14.1%）占主要部分。大肠埃希菌对亚胺培南的耐药率从早期组的14.3%增加至近期组的25.9%（P=0.026），而肺炎克雷伯杆菌对亚胺培南的耐药率无明显变化。超广谱β内酰胺酶（ESBL）阴性大肠埃希菌和肺炎克雷伯杆菌对亚胺培南的耐药率高于ESBL阳性菌（P＜0.001）。肠球菌对氨苄西林和莫西沙星的耐药率显著升高（P=0.01；P=0.02）。葡萄球菌属和真菌的抗生素耐药率在前后两阶段无明显改变（P＞0.05）。结论  革兰阴性菌是肠外瘘致腹腔感染的主要病原菌，细菌对抗生素尤其是碳青霉烯类药物的耐药率明显升高，应严密监测以指导抗菌药物的规范化使用。

关键词: 肠外瘘, 腹腔感染, 原病菌, 耐药性