肛周会阴部坏死性筋膜炎病原菌分布及耐药性分析

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【中图分类号】R657.1 【文献标志码】A

Pathogen distribution and drug resistance in patients with Fournier's gangrene

Zhang Jiayuan I ，Lu Jingen'，Wang Qiantao²，Wang Chen'，Yao Yibo' （1.DepartmentofAnorectal Surgery，Longhua HospitalAffliated to Shanghai UniversityofTraditional Chinese Medicine;2.Department of Traditional Chinese Medicine，Shanghai Sixth People's Hospital）

【AbstractObjective：ToinvestigatethedistributionofpathogensandtheresultsofdugsensitivitytestinpatientswithFouier’s gangrene（FG）andtoprovideabasisforrationaluseofantibiotics inthetreatmentofsevereinfectiousdiseases.Methods：Aretospectiveanalysisaspeforedfortedataof64patintswitFGhoereadmitedtoDepartmentofAnorectalSurgery，LonghaHospitalAfilatedtoSanghaiUnversityofTaditioalCineseMdicine，fromJanuary15toJune222ncludingiicaldataadthe resultsofacterialcultureanddrugsensitivitytest.Results：Amongthe64microbialestreports，therewere12caseswithoutpathogen growthand52caseswithpathogengrowth，andatotalof79pathogenicstrainswereisolated.MostpathogenicbacteriawereGramnegative bacteria，with two dominantbacteria of Escherichia coli（25/79，31.65 % ）andKlebsiella pneumoniae 22/79，27.85% ）. The resultsof drug sensitivitytestshowed that theresistancerateofGram-positivebacteria topenicillin Greachedas high as 78.57% ，with a sensitivity rate of 100% tovancomycin；Gram-negative bacteria had aresistance rate of > 50% to ampicillin，ceftriaxone， sulfamethoxazle-timeopri，evofloacin，ndapicilibacta，ithelatielyighssitivitytopem，o andamikacin.Byaalyzngtecoelationofthetypesofpathognswithmortaityate，lengthofospitalstayandFouer'sGangreneSeverityIndex（FGSI）score，itwasfoundthatthelengthofhospitalstayinthemixedbacterialinfectiongroupwas 4.287days longer than that in the Gram-negative bacterialinfection group， whilethe types of pathogenswere not correlated with mortalityrate orFGSI score.Conclusion：FG ismainly caused by Gram-negative bacteria，and earlyand sufficient use of carbapenems，glycopeptides，and nitroimidazoles canachieve a higher coverage rateof pathogenicbacteria.Pathogenicbacteria tendtohavealowsensitivitytocommon antibiotics，and thereare increasesin the types and numbers of drug-resistant strains compared with previous reports， suggestingthattheuseofantibioticsshouldbestandardizedinclinicalpracticetoreducetheproductionofdrugresistantstrains. 【Key words】Fournier's gangrene;pathogenic bacteria;resistance;antibiotic regimen

肛周会阴部坏死性筋膜炎（Fournier'sgangrene，FG）是一种发病率低但进展迅速、危及生命的急性软组织感染性疾病[-2。（剩余11145字）