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• W2620165089 abstract "Objective: To investigate the characteristics of spectrum and drug resistance of pathogens causing sepsis in patients with severe acute pancreatitis(SAP). Methods: The clinical data of 63 SAP patients with sepsis admitted in Department of Hepatobiliary, People's Liberation Army General Hospital from January 2014 to December 2015 were retrospectively studied. There were 47 males and 16 females, aged from 22 to 73 years, with an average age of (52±11)years. Samples were collected mainly from: (1)pancreatic and peripancreatic necrosis and abdominal drainage; (2)bile; (3) blood or deep venous catheter; (4) sputum and tracheal catheter and thoracic drainage; (5) urine. Strain identification and drug-resistance test were preformed on positive specimens. Results: Of 244 pathogenic isolates, mainly derived from abdominal cavity(36.0%), blood stream (14.0%), central venous catheter(11.8%), necrotic tissue(9.1%) and sputum(8.1%); 154(63.1%) were gram-negative bacteria, 68 cases(27.9%) were gram-positive bacteria and 22 cases(9.0%) were fungi respectively. The top six common pathogens isolated were E. coli(16.0%), E.faecium and faecalis(15.2%), P.aeruginosa(10.7%), K.pneumonia(9.8%), Acinetobacter baumanni(8.2%), Stenotrophomonas maltophilia(5.3%)respectively. The detection rate of E. coli and K. pneumonia extended-spectrum β-lactamases(ESBL) was 84.6%(33/39) and 70.8%(17/24), the resistance rate to imipeniem was 12.8% and 25.0%, to cefperazone-sulbactam was 28.2% and 29.2%. As to P. aeruginosa and Acinetobacter bacillus, the resistance rate to imipeniem was 50.0% and 75.0%, to cefperazone-sulbactam was 42.3% and 70.0%; Stenotrophomonas maltophilia was completely resistant to cefperazone-sulbactam, but sensitive to minocycline, SMZ-TMP with the resistance rate less than 40.0%. Gram-positive bacterium strains mainly included E. faecium(38.2%, 26/68), E.faecalis(16.2%, 11/68) and Staphylococcus(35.3%, 24/68) which maintained high sensitivity to vancomycin, teicoplanin and linezolid, there was only one isolate resistant to vancomycin. Candida were the sole pathogens of fungal infections, sensitive to common antifungal drugs overall. Conclusions: The gram-negative bacteria are the predominant pathogens mainly including ESBL-producing isolates(E.coli and K. pneumonia) and non-fermentation bacteria(P.aeruginosa and Acinetobacter bacillus) causing sepsis in SAP. The infection rate and drug-resistance rate of these two kinds of pathogens are relatively higher.目的： 探讨重症急性胰腺炎(SAP)继发脓毒症病原菌菌谱特点及耐药情况。 方法： 回顾性分析2014年1月至2015年12月解放军总医院肝胆外科连续收治的63例有明确病原菌感染依据的SAP患者的病例资料。男性47例，女性16例；年龄22～73岁，平均(52±11)岁。送检标本来源包括：(1)胰腺、胰周坏死组织及腹腔引流液；(2)胆汁；(3)血液或深静脉导管；(4)痰液、气管导管及胸腔引流液；(5)尿液。对阳性送检标本进行菌株鉴定及药物敏感试验。 结果： 63例患者中共分离出病原菌244株，分别来自腹腔(36.0%)、血液(14.0%)、中心静脉导管(11.8%)、坏死组织(9.1%)及痰液(8.1%)。革兰阴性菌154株(63.1%)，革兰阳性菌68株(27.9%)，真菌22株(9.0%)；前6位的病原菌依次为大肠埃希菌(16.0%)，屎肠球菌和粪肠球菌(15.2%)，铜绿假单胞菌(10.7%)，肺炎克雷伯菌(9.8%)，鲍曼不动杆菌(8.2%)，嗜麦芽窄食假单胞菌(5.3%)。大肠埃希菌与肺炎克雷伯菌产超广谱β-内酰胺酶(ESBL)阳性菌株分别占84.6%(33/39)和70.8%(17/24)，对亚胺培南西司他丁钠的耐药率分别为12.8%和25.0%，对头孢哌酮舒巴坦钠的耐药率分别为28.2%和29.2%；铜绿假单胞菌和鲍曼不动杆菌对亚胺培南西司他丁钠的耐药率分别为50.0%和75.0%，对头孢哌酮舒巴坦钠的耐药率分别为42.3%和70.0%；嗜麦芽窄食假单胞菌对亚胺培南西司他丁钠的耐药率达100%，对米诺环素、复方新诺明等药物耐药率<40.0%；屎肠球菌、粪肠球菌及葡萄球菌属对万古霉素、替考拉宁和利奈唑胺均保持高敏感性，仅有1株屎肠球菌对万古霉素耐药；真菌感染全部为念珠菌属，对常用的抗真菌药物保持较高的敏感性。 结论： SAP继发脓毒症病原菌以革兰阴性菌为主，主要包含大肠埃希菌、肺炎克雷伯菌ESBL阳性菌和包含鲍曼不动杆菌、铜绿假单胞菌在内的非发酵菌，其感染率和耐药率均居较高水平。革兰阳性菌和真菌的感染亦不容忽视。." @default.
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• W2620165089 title "[Analysis of the spectrum and resistance of pathogen causing sepsis in patients with severe acute pancreatitis]." @default.
• W2620165089 doi "https://doi.org/10.3760/cma.j.issn.0529-5815.2017.05.014" @default.
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