目的：研究急性坏死性胰腺炎（ANP）合并感染的病原菌分布及耐药性，并探讨其对ANP患者预后的影响。 方法：回顾性分析2010年10月—2014年10月收治的72例有明确病原学依据的ANP合并感染患者的临床资料。 结果： 72例ANP患者中，腹腔及腹膜后感染47例（65.28%），呼吸道感染37例（51.39%），血流感染32例（44.44%），其中血流感染与患者死亡密切相关（P<0.05）。检出病原菌235株，其中革兰阴性细菌159株（67.66%），革兰阳性细菌60株（25.53%），真菌16株（6.81%）。获得的病原菌中排名前6位的依次是：鲍曼不动杆菌（24.68%），铜绿假单胞菌（8.94%），肺炎克雷伯菌（8.09%），屎肠球菌/粪肠球菌（8.09%），大肠埃希菌（7.66%），金黄色葡萄球菌（4.68%）。耐药性分析显示，鲍曼不动杆菌和铜绿假单胞菌对亚胺培南耐药率分别达95.92%和52.63%，对头孢哌酮/舒巴坦的耐药率分别为59.26%和50.00%。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶（ESBLs）检出率分别为64.29%和80.00%，对头孢哌酮/舒巴坦的耐药率分别为31.58%和18.75%，而对亚胺培南的耐药率分别为23.08%和7.14%。19株屎肠球菌/粪肠球菌中仅1株对万古霉素耐药，对利奈唑烷尚未发现耐药菌株。耐甲氧西林金黄色葡萄球菌检出率为72.73%，对万古霉素、利奈唑烷和呋喃妥因尚未发现耐药菌株。16株真菌对常用抗真菌药物均未发现耐药菌株。 结论：血流感染是ANP患者死亡的重要原因。ANP患者的病原菌仍以革兰阴性菌为主，但革兰阳性菌和真菌的比例不容忽视。多重耐药菌已成为ANP合并感染的巨大的挑战。
Acute necrotizing pancreatitis and associated infection: pathogens and antimicrobial resistance
Objective: To investigate the distribution and antimicrobial resistance of pathogens isolated from infections associated with acute necrotizing pancreatitis (ANP) and analyze their impacts on prognosis of the patients. Methods: The clinical data of 72 ANP patients complicated with infection admitted from October 2010 to October 2014 were retrospectively studied. Results: Of the 72 ANP patients, there were 47 cases (65.28%) with abdominal and retroperitoneal infection, 37 cases (51.39%) with respiratory infection, and 32 cases (44.44%) with bloodstream infection, and bloodstream infection was closely related to death of the patients (P<0.05). Of 235 pathogenic isolates, 159 (67.66%) were gram-negative bacteria, 60 (25.53%) were gram-positive bacteria and 16 (6.81%) were fungi, respectively. The top six common pathogens isolated were Acinetobacter baumanni (58 isolates, 24.68%), Pseudomonas aeruginosa (21 isolates, 8.94%), Klebsiella pneumonia (19 isolates, 8.09%), Enterococcus faecium/faecalis (19 isolates, 8.09%), Escherichia coli (18 isolates, 7.66%) and Staphylococcus aureus (11 isolates, 4.68%), respectively. Antimicrobial susceptibility testing indicated that the resistant rate for Acinetobacter baumanni and Pseudomonas aeruginosa to imipeniem was 95.92% and 52.63%, and to cefperazone-sulbactam was 59.26% and 50.00%, respectively. The detection rate of extended-spectrum β-lactamases (ESBLs) in Klebsiella pneumonia and Escherichia coli was 64.29% and 80.00%, respectively. The resistance rate of Klebsiella pneumonia and Escherichia coli to cefperazone-sulbactam was 31.58% and 18.75%, and to imipeniem was 23.08% and 7.14%, respectively. Of the 19 isolates of Enterococcus faecium/faecalis, there was only one isolate resistant to vancomycin, and no linezolid-resistant isolate was found. The detection rate of Methicilin-resistant Staphylococcus aureus was 72.73%, and no isolate resistant to vancomycin, linezolid or macrodantin was noted. None of the 16 isolates was found resistant to common antifungal drugs. Conclusion: Bloodstream infection is an important cause for death in ANP patients. The gram-negative bacteria are still the major pathogens causing infections in ANP patients, however, the proportion of gram-positive bacteria and fungi should not be neglected. Multi-drug resistant bacteria have become an increasing challenge to the treatment of ANP associated with infections.