| Objective:In order to understand the distribution of isolated bacteria in the abdominal cavity of patients with intra-abdominal infections(IAIs)and their resistance to antibiotics,it provides an important basis for clinical empirical treatment against infections and rational use of antibiotics.Methods:Bacteria cultured and isolated from the abdominal cavity specimens of our hospital from October 2017 to September 2019 were collected.The strains were identified by biomerieux company MOLDI-TOF MS mass spectrometer.The antimicrobial drug sensitivity test was conducted using biomerieux company Vitek 2 compact automatic drug sensitivity system.The results were interpreted according to the 2017 edition of American institute of clinical and laboratory standards CLSI standards.Statistical analysis was performed using WHONET5.6 software(recommended by the who bacterial resistance monitoring center).Results:1.Distribution and proportion of isolated bacteria in patients with abdominal infectionAbdominal cavity specimens were collected from 954 patients with abdominal infection in our hospital,and 1174 strains of bacteria wereisolated(the first strain of the same bacteria isolated from the same patient was retained).There were 690 cases of single bacterial infection,accounting for 72%(690/954),264 cases of mixed bacterial infection,accounting for 28%(264/954),229 cases of mixed bacterial infection,and 35 cases of three bacterial infections.There were 143 cases of mixed infection with two gram-negative bacteria accounting for 54.2%(143/264),and 74 cases of mixed infection with gram-negative bacteria and gram-positive bacteria accounting for 28.0%(74/264).The most common bacteria isolated from patients with abdominal infection were392 strains of escherichia coli,accounting for 33.4% of the total number of bacteria.Klebsiella pneumoniae 285 strains accounting for 24.3%;There were 59 strains of enterococcus faecium,accounting for 5.0%.There were 51 strains of enterococcus faecalis,accounting for 4.3%.There were 46 strains of pseudomonas aeruginosa accounting for3.9%.2.Analysis of antimicrobial susceptibility of common bacteria isolated by abdominal infectionEscherichia coli had the highest sensitivity to carbapenem antibiotics,with a sensitivity rate of 100% for meropenem and 99.2% for imipenem,followed by amikacin and cefotetan,with sensitivity rates of 98.7% and97.6%,respectively.The most sensitive antimicrobial agents of klebsiella pneumoniae were carbapenems.The sensitivity rates of imipenem and meropenem were over 99%,and the sensitivity rates of cefotetam andamikacin were 98.5% and 97.8% respectively.In addition,the sensitivity of two common gram-negative bacilli to a combination of penicillin and enzyme inhibitors(piperacillin/tazobactam)exceeded 95%.The resistance rates of common non-fermentable bacteria to commonly used antimicrobial drugs were all high,and the sensitivity of pseudomonas aeruginosa to carbapenems was only about 60%.The sensitive drugs were amikacin,ceftazidine and tobramycin,with the sensitivity rates of 95.5%,88.6% and 88.6%,respectively.The sensitive drugs to acinetobacter baumannii were amikacin and levofloxacin,with the sensitivity rates of 37.5% and 36.8%,and the sensitivity to carbapenem antibiotics was less than 30%.Among common gram-positive cocci,ampicillin has a low sensitivity to enterococcus faecium,with a sensitivity rate of only 26.4%,and a high sensitivity to enterococcus faecalis,with a sensitivity rate of97.9%.The sensitivity of the two positive cocci to linezolid was higher,and the sensitivity rate was above 90%.No vancomycin-resistant enterococcus faecium and enterococcus faecalis were found.3.The distribution of major bacteria isolated from abdominal cavity specimens of patients in different departments and the sensitivity of antimicrobial agentsThere were 739 strains of isolated bacteria in hepatobiliary and pancreatic surgery,389 strains in gastrointestinal and colorectal surgery,and 46 strains in ICU.Separation of the three departments are the mostcommon bacteria were E.coli,including hepatobiliary and pancreatic surgery 221 strains accounted for 29.9%(221/739),163 strains accounted for 41.9%(163/389)in gastrointestinal and colorectal surgery,ICU separation 8 strains accounted for 17.4%(8/46),followed by pneumonia klebsiella bacteria,including 217 strains accounted for 29.4%(217/739)in gastrointestinal and colorectal surgery,57 strains accounted for 14.7%(57/389)in gastrointestinal and colorectal surgery,11 strains accounted for 24.0%(11/46)in ICU.The drug resistance rate of escherichia coli isolated from hepatobiliary and pancreatic surgery was slightly lower than that of bacteria isolated from gastrointestinal and colorectal surgery.The drug resistance rates to cefazolin were 50.2% and 55%,ceftriaxone 46.4% and51.2%,and levofloxacin 64.3% and 66.8%,respectively.The drug resistance rate of klebsiella pneumoniae isolated from hepatobiliary surgery was significantly lower than that of bacteria isolated from gastrointestinal colorectal surgery.The drug resistance rates of cefazolin,ceftriaxone and levofloxacin were 16.3% and 40%,13.9% and 31.6%,and 13.3% and 31.6%,respectively.4.The distribution of main bacteria isolated from single bacterial infection and mixed bacterial infection and the sensitivity of antimicrobial agents679 strains of bacteria were isolated from 690 patients with single bacterial infection(the first strain of the same isolated bacteria from thesame patient),and 495 strains were isolated from 264 patients with mixed bacterial infection(the first strain of the same isolated bacteria from the same patient).The most common pathogens of the two infection types were escherichia coli.249 strains were isolated by single bacterial infection,accounting for 36.7%(249/679),and 143 strains were isolated by mixed infection,accounting for 28.9%(143/495).The second was klebsiella pneumoniae,202 strains isolated by single infection accounting for 29.7%(202/679),and 83 strains isolated by mixed infection accounting for 16.8%(83/495).Enterococcus and non-fermentative bacteria are also common.The resistance rates of escherichia coli isolated from the two infection types to common antibiotics were basically similar,and the sensitivity of escherichia coli to the combination of carbapenems and penicillin and enzyme inhibitors was relatively high.The sensitivity rates to meropenem were 100%,and to piperacillin/tazobactam were 96.7%and 96.9%,respectively.The drug resistance rate of klebsiella pneumoniae to cephalosporins and fluoroquinolones was higher than that of single bacterial infection,38.2% and 14.8% to cefazolin,34.6% and11.1% to ceftriaxone,38.5% and 14.7% to levofloxacin,and 60.3% and27% to ciprofloxacin.5.The distribution of main bacteria isolated from different infected sites and their sensitivity to antimicrobial agentsAmong the 954 patients with peritoneal infection,there were 421 biliary tract isolates,136 pancreatic isolates,124 liver abscesses and 493 other isolates.The most common bacteria isolated from patients with biliary tract infection were Escherichia coli,159 strains of which accounted for 37.8%(159/421),followed by 75 strains of klebsiella pneumoniae accounting for 17.8%(75/421)and 32 strains of enterococcus faecium accounting for 7.6%(32/421).The most common isolates of pancreatic infection were 36 strains of Escherichia coli accounting for 26.5%(36/136),followed by 21 strains of klebsiella pneumoniae accounting for 15.4%(21/136)and 15 strains of pseudomonas aeruginosa accounting for 11%(15/136).Liver abscesses were most common with 94 strains of klebsiella pneumoniae accounting for 75.8%(94/124),followed by 11 strains of escherichia coli accounting for 8.9%(11/124);among other infections,186 strains of escherichia coli were the most common,accounting for 37.7%(186/493),followed by 95 strains of klebsiella pneumoniae accounting for 19.3%(95/193),and 22 strains of enterococcus faecalis accounting for 4.5%(22/493).There were 234 cases of biliary tract infection caused by single bacteria,accounting for 69.6%(234/336),and 102 cases of mixed bacterial infection,accounting for 30.4%(102/336).There were 79 cases of single bacterial infection,accounting for 70.5%(79/112),and 33 cases of mixed infection,accounting for 29.5%(33/112).There were 109 cases of single bacterial infection in liver abscess,accounting for 91.6%(109/119),and 10 cases of mixed infection,accounting for 8.4%(10/119).Different infection parts separation of E.coli and klebsiella pneumonia on carbon penicillium alkene sensitive rate is highest,in addition to other patients with abdominal cavity infection and 1 carbon penicillium strain was isolated outside the drug resistance of klebsiella pneumoniae,all sensitive,followed by piperacillin/tazobactam,cefoperazone/sulbactam and amikacin sensitivity best,the drug resistance rate is respectively(0-3%),(0-6.1%)and(0-5.6%).The drug resistance rate of klebsiella pneumoniae isolated from liver abscess was significantly lower than that of bacteria isolated from other types of infection,including 1.1% resistance rate to cefazolin and28.1%-38.9% resistance rate to other types of infection.The resistance rate to cefuroxime was 3.4%,and 3.9%-45.7% to other types of infection.The drug resistance rate to ceftriaxone was 1.1%,and that to other types of infection was 21.7%-33.3%.The resistance rate to ciprofloxacin was10.2%,and 38.5%-77.8% to other types of infection.Conclusion:1.Enterobacteriaceae bacteria are the most common isolates of intra-abdominal infections,escherichia coli and klebsiella pneumoniae are the top two.Enterococci are the most common gram-positive bacteria in abdominal cavity.2.Most of the intra-abdominal infections in our hospital were caused by single bacteria,and a few were mixed.The rate of liver abscesses caused by a single bacterial infection is higher,more than 90%,with klebsiella pneumoniae being the most common.3.The sensitivity of common gram-negative bacilli to carbapenems was the highest,and the sensitivity of common gram-positive coccus to vancomycin was the highest.4.There was no significant difference in the drug resistance rate of escherichia coli isolated from different types of peritoneal infection to commonly used antibiotics,and the drug resistance rate of klebsiella pneumoniae isolated from liver abscess to commonly used antibiotics was significantly lower than that of bacteria isolated from other types of infection. |
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