喉癌术后患者医院感染的病原菌分布及耐药性分析  

Pathogenic bacteria causing nosocomial infections in laryngocarcinoma patients after surgery and its drug resistance

作　　者：傅江涛[1] 黄庆琳[1] 金枫桐[1] 陈剑波[1] 沈川[1] 

机构地区：[1]丽水市人民医院耳鼻咽喉头颈外科,浙江丽水323000

出　　处：《中华医院感染学杂志》2012年第8期1739-1741,共3页Chinese Journal of Nosocomiology

摘　　要：目的观察喉癌术后患者医院感染的临床特点,为临床工作提供支持。方法回顾性分析54例喉癌术后感染患者的临床资料,统计其医院感染发生部位、致病菌种类及其耐药率、预后的影响。结果 54例患者中肺部感染36例,占66.67%,手术切口感染11例,占20.37%,泌尿系感染6例,占11.11%;共培养出病原菌87株,其中革兰阴性菌51株,占58.62%,革兰阳性菌28株,占32.18%,真菌8株,占9.20%;革兰阳性菌中金黄色葡萄球菌和溶血葡萄球菌对万古霉素高度敏感;革兰阴性菌中铜绿假单胞菌和肺炎克雷伯菌对亚胺培南高度敏感;住院时间长、年龄>60岁患者且长期吸烟史、肾上腺皮质激素应用时间长及预防性应用抗菌药物是发生医院感染的危险因素;该组患者死亡10例,死亡率为18.52%。结论喉癌围术期要严格无菌操作,临床应加强预防医院感染的管理,减少医院感染的发生;对感染的患者及时进行分泌物细菌培养及耐药性的检测,对指导临床合理用药具有重要意义。OBJECTIVE To study clinical characteristics of nosocomial infections in laryngocarcinoma patients after operation,so as to support the clinical work.METHODS The clinical data of 54 laryngocarcinoma patients with postoperative infections were retrospectively analyzed.Statistical analysis of the infection sites,species of pathogens,resistance rates,and the prognosis was performed.RESULTS Of the 54 patients with nosocomial infections,pulmonary infections occurred in 36 cases（66.67%）,surgical site infections in 11 cases（20.37%）,urinary tract infections in 6 cases（11.11%）.Totally 87 strains of pathogen bacteria were isolated,including 51 strains（58.62%） of gram-negative bacilli,28 strains（32.18%） of gram-positive bacteria,and 8 strains（9.20%） of fungi.Among gram-positive bacteria,Staphylococcus aureus and S.haemolyticus were highly susceptible to vancomycin;among gram-negative bacteria,Pseudomonas aeruginosa and Klebsiella pneumonia were highly susceptible to imipenem.Long hospital stay,60 years of age or older with smoking history,long time of using glucocorticoid hormore,and prophylactic antibiotics were the risk factors for nosocomial infections.Ten cases in this group died with the mortality of 18.52%.CONCLUSION The strict aseptic operation is important for laryngocarcinoma surgery.Control of hospital infections should be strengthened to reduce the incidence of nosocomial infections.For the patients with infections,timely bacterial culture for secretions and test for drug resistance should be performed,which has great significance in directing the reasonable use of antibiotics.

关 键 词：喉癌手术 医院感染 细菌培养 病原菌 药敏率 

分 类 号：R378[医药卫生—病原生物学]