| Objective To analyze the distribution and drug resistance of the pathogens culturedfrom the submitted specimens in gastrointestinal surgery of the first Hospital of Jilin Universityand explorethe drug resistant mechanisms so as to guide the reasonable medication。Methods The source of the culture specimens,distribution of pathogens,and the drugresistance were taken for statistical analysis from 2014 to 2016.Bacteriaidentification and drug sensitivity tests were conducted by VITEK-2 Compactautomatic identification method and other supportive tests.The data wascollectedby WHONET 5.4,and the clinical distribution and drug resistance of the strainswere analyzed by SPSS 18.0.Results 1.Basic situation of samples for inspection 1.1.specimen detection rate In 2014-2016 years,the detection rate of total specimens was 34.4%(3477/10117),and the detection rate was 38.2(1214/3176)in 2014.The detection rate in 2015 was 34.2%(1134/3314),and the detection rate in 2016 was 31.1%(1129/3627).The detection rate of specimens decreased year by year in three year 1.2.Detection rate of patient The total detection rate of patient from 2014 to 2016 is 43.3%(2600/6004),2014 with a detection rate of 45.9%(890 /1939),2015 with a detection rate of 43.9(848/1932),2016 with a detection rate of 40.4(862/2133),The detection rate of patientin 2014-2016 is decreased year by year.1.3.Type of specimen In the past 2014-2016 years,10117 cases were sent to gastrointestinal surgery in our hospital,the most specimen was drainage fluid(45.8%,4630/10117),followed by sputum(36.2%,3665/10117),and blood(6.6%,668/10117).2.Distribution of pathogenic bacteria In the 2014-2016 years,4183 strains of bacteria were detected in the specimens of gastrointestinal surgery in our hospital,Bacteria accounted for 80.4%(3362/4183),and fungi accounted for 19.6%(821/4183).In the past three years,the detection strains were mainly G-bacteria(62.4%(2609/4183)),followed by G+ bacteria(753/4183),and the fungi were the least.The proportion of fungi increased in the past three years.3.Pathogenic bacteria type The detection of pathogenic bacteria,G-bacteria in the top 5 for Escherichia coli,Klebsiellapneumoniae,Pseudomonas aeruginosa,Bauman Acinetobacter,Enterobacter cloacae,G+ bacteria in the top 5 for Enterococcus faecium,Enterococcus faecalis,Staphylococcus aureus,Streptococcus,Staphylococcus epidermidis,common bacteria in the fungus are Candida albicans,Candida smooth,other yeasts(Candida),Candida tropicalis,and Candida kuru 4.Distribution of pathogenic bacteria in common diseases of gastrointestinal surgery Gastroduodenal cancer patients isolated pathogens more Klebsiella pneumoniae,a higher proportion of fungi.The pathogen of colorectal cancer patients is mainly Escherichia coli.Intestinal obstruction,perforation of digestive tract,and pathogenic bacteria in appendicitis were mainly Escherichia coli.During the three years,the distribution of pathogenic bacteria continued to change,but there was no significant change in the overall trend.5.Drug resistance of pathogenic bacteria The resistance rate of Escherichia coli to carbendazimes such as meropenem and imipenem is extremely low,showing that E.coli is highly sensitive to meropenem and imipenem.However,in 2016,drug-resistant strains began to emerge,that is,resistant to carbonases.Klebsiella pneumoniae is highly sensitive to carbapenem antibiotics such as imipenem and meropenem,but in recent years Klebsiella pneumoniae has increased resistance to imipenem and meropenem and is resistant to carbonase.The number of genomic strains increased gradually.Pseudomonasaeruginosahas a low resistance rate to piperacillin/sulbactam,piperacillin,fourth-generation cephalosporins such as cefepime,quinolones such as levofloxacin and carbapenems such as meropenem.Acinetobacter baumannii is resistant to multiple antibiotics.In 2016,gastrointestinal surgery detected Acinetobacter baumannii all resistant to minocycline.No resistance to tigecycline was found in Acinetobacter baumannii.Enterococcus faecium and Enterococcus faecalis have extremely low resistance to tigecycline,teicoplanin,high concentrations of streptomycin,and linezolid.Resistance to other common antimicrobials is high.In conclusion: 1.In 2014-2016,the pathogens detected in gastrointestinal surgery in our hospital were mainly gram-negative bacteria,followed by gram-positive bacteria and fungi.The rate of fungal detection continues to increase during the three years and needs to be taken seriously by clinicians.2.Among the pathogens detected,the G-bacteria were Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii.The G+ bacteria were Enterococcus faecalis,Enterococcus faecium,and fungi.Candida mainly.3.The drug resistance of pathogenic bacteria detected in gastrointestinal surgery has been continuously changing during the three years.Gram-negative bacteria generally have low resistance to carbapenems(meropenem),but in recent years,carbonase-resistant penicillin-type strains have appeared.Enterococcus faecalis and Enterococcus faecium in Gram-positive bacilli generally have low resistance to vancomycin,linezolid,and teicoplanin. |
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