| Multiple resistant bacteria refers to the bacteria with multiple drug resistance.Multiresistance is defined as resistance of bacteria to at least three antibiotics such as aminoglycosides,erythromycin or beta-lactams.To date,the most common multiple resistant bacteria included methicillin resistant staphylococcus aureus(MRSA),vancocin resistant enterococcus(VRE),extended spectrum β lactamases(ESBLs),carbapenems resistant Enterobacteriaceae(CRE),carbapenems resistant Acinetobacter baumannii(CR-AB),multidrug resistant/pan-drug resistant Pseudomonas aeruginosa(MDR/PDR-PA)and multidrug resistant Mycobacterium tuberculosis.P-resistant bacteria were almost resistant to any agents,such as Pan-Acinetobacter that were resistant to aminoglycoside,penicillin,cephalosporin,carbapenem,tetracycline or sulfonamides.With the extensive application of antibiotics,multiple resistant bacteria has been considered as a severe threat in clinical settings,which can affect the surgery and patient prognosis.General surgery involves various disease and large surgical wound.Postoperative recovery is slow,and it is also a serious disaster area for multi-drug resistant bacterial infection.In clinical settings,antibiotics are usually required in terms of anti-inflammatory conservative treatment or surgical treatment.As bacterial culture identification and drug sensitivity test results in lag behind clinical anti-infective treatment,most of the initial clinical anti-infective treatment is based on empirical treatment,and the important basis of empirical treatment mainly depends on epidemiological data.In cases of the patient is infected with multi-drug-resistant bacteria,early diagnosis is not possible,which then will affect the treatment effect,and prolong the length of hospital stay,increase the patient’s pain and financial burden,as well as serious danger to the patient’s life and safety.Objective:There are differences in the data of multidrug-resistant bacteria in different detection networks,different regions,different hospitals or different departments of the same hospital and different periods.The distribution of patients and diseases in our department is basically stable.Based on the research and analysis of the disease types,drug-resistant bacteria types,antibiotics used and prognosis of patients with multiple drug-resistant bacteria in our department,we can guide clinical medication.To understand alternation of bacterial resistance in hepatobiliary surgery is of great importance to guide the correct and rational use of antibiotics in clinic,preventing and treating infections caused by multi-drug resistant pathogens effectively.Methods:Through the registration data of multi-drug-resistant bacteria patients and the database of multi-drug-resistant bacteria patients in the hospital infection department,we collected and analyzed the disease types,drug-resistant bacteria types and sensitive antibiotics types of patients with multi-drug-resistant bacteria infections in our department.Statistical analysis was performed to investigate the relationship between the disease types and pathogenic bacteria,pathogenic bacteria and sensitive antibiotics types.Meriere automatic bacterial identification and drug sensitivity analyzer,ATB manual identification and drug sensitivity system were used for bacterial identification and drug sensitivity test.Drug sensitivity test was carried out according to the method recommended by CLSI 2015 standard.All the data were analyzed by SPSS17.0 statistical software.The counting data were expressed by the number of cases and percentage.The bacterial species were analyzed by descriptive statistical analysis and chi-square test.Results:A total of 845 strains of multi-drug resistant bacteria were isolated from the Department of hepatobiliary surgery in our hospital from 2016 to 2018.The top five bacteria were Escherichia coli,Klebsiella pneumoniae,Enterococcus faecalis,P.aeruginosa and Acinetobacter baumannii.Among the top five bacteria,the detection rate of E.coli was the highest,235 strains accounted for 47.8% of the negative bacteria,followed by K.pneumoniae,152 strains accounted for 30.9% of the negative bacteria,P.aeruginosa,66 strains accounted for 13.4% of the negative bacteria,A.baumannii,ranked fourth,with 39 cases detected.The proportion of negative bacilli was 7.9%.Enterococcus faecium had the highest isolation rate of 109 Gram-positive bacteria,and the rate of Gram-positive bacteria was 50.0%.Of the top five bacterial species,there were four Gram-negative bacteria and only one Gram-positive bacteria.Chi-square test showed that there was no significant difference in the proportion of MDRO patients between 2016 and2018(P > 0.05).The drug sensitivity of the first five multidrug-resistant bacteria is as follows:E.coli:The sensitive antibiotics were as follows: Carbapenems: imipenem,meropenem,biapenem,panipenem;aminoglycosides: amikacin,sensitivity greater than 95%;piperacillin sodium tazobactam,cefoperazone sulbactam,cefoxitin,levofloxacin and gentamicin,with a sensitivity of greater than 50%.The resistant antibiotics were ampicillin,ceftriaxone,cefazolin sodium,cefotaxime sodium and aztreonam.The drug resistance was more than 50%.Klebsiella pneumoniae:The susceptible antibiotics were carbapenems: imipenem,meropenem,biapenem and panipenem;aminoglycosides: amikacin,cefoxitin,piperacillin sodium,tazobactam,gentamicin,levofloxacin,ceftazidime,compound neonolamine,aztreonam,cefepime.The sensitivity was more than 50%.The resistant antibiotics were ampicillin and cefazolin sodium,and the drug resistance was more than 50%.Enterococcus faecium:The sensitive antibiotics were vancomycin,linezolid,dafostine and high concentration streptomycin in turn.The sensitivity was more than 50%.The resistant antibiotics were ampicillin,levofloxacin and rifampicin.The drug resistance was more than 50%.Pseudomonas aeruginosa:The sensitive antibiotics were aminoglycosides: amikacin,gentamicin,levofloxacin,ceftazidime,piperacillin sodium,tazobactam,cefepime,meropenem,imipenem,cefoperazone sulbactam,piperacillin,aztreonam.The sensitivity was more than 50%.The resistant antibiotics were Biapenem,and the drug resistance was close to 50%.Acinetobacter baumannii:The sensitive antibiotics were aminoglycosides: amikacin,compound neonamicin,and the sensitivity was close to 50%.The drug-resistant antibiotics were piperacillin sodium tazobactam,carbapenems imipenem,meropenem,biapenem and panipenem.The drug-resistant rates were 100%,followed by gentamicin,ceftazidime,cefepime,cefoperazone sulbactam,ampicillin sulbactam and levofloxacin.The drug resistance was more than 50%.Conclusion:According to the summary and analysis of multi-drug-resistant bacteria in our department in recent three years,among the top five bacteria,there are four Gram-negative bacteria and only one Gram-positive bacteria.The sources of bacterial culture were bile,pus,peritoneal effusion and blood.Unlike the common pathogenic bacteria in textbooks,each hospital had its own characteristics of multi-drug-resistant bacteria in hepatobiliary surgery.The top five bacteria were all multi-drug-resistant bacteria.They were generally resistant to commonly used antibiotics in clinic.Timely and effective empirical medication can control infection immediately,alleviate the disease,and gain time for the targeted application of antibiotics after bacterial culture and drug sensitivity test.The results of experiential drug use and susceptibility test for the above resistant bacteria in our department were different from those of the world-class and national antibiotic application guidelines.Significance:After summarizing and analyzing the types and specific drug resistance of multi-drug resistant bacteria in our department in recent three years,we can find out the possible pathogenic bacteria for a certain disease.This kind of multi-drug resistant bacteria was sensitive to certain antibiotics and resistant to them.It had a certain guiding role for our department’s experience in drug use.It can be positive and effective for infection before the results of bacterial culture and drug sensitivity appear. |
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