经皮肾镜取石术后感染的病原菌及药敏分析  

INFECTION FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY: PATHOGENIC BACTERIA AND DRUG SENSITIVITY

作　　者：王方明[1] 张桂铭[1] 官丰菊[2] 孙立江[1] 

机构地区：[1]青岛大学医学院附属医院泌尿外科,山东青岛266003 [2]青岛大学医学院附属医院手术室,山东青岛266003

出　　处：《齐鲁医学杂志》2012年第4期348-351,共4页Medical Journal of Qilu

摘　　要：目的了解经皮肾镜取石术(PNL)后感染的病原菌分布及其耐药情况,从而为PNL术后的抗生素应用提供临床依据。方法回顾性分析2006年9月—2011年12月在我院行PNL治疗461例病人的临床资料,对术后体温超过38℃者行血、尿培养,对体温37.3～38.0℃且持续3d以上考虑为术后感染的病人只进行尿培养,对阳性结果进行菌种鉴定和耐药性检测。结果术后体温超过38.0℃的病人有64例,共培养出18种78株病原菌,血培养结果显示:大肠埃希菌占31.82%,铜绿假单胞菌占22.73%,克雷伯菌占13.64%,葡萄球菌占31.82%;尿培养结果显示:大肠埃希菌、铜绿假单胞菌、克雷伯菌、葡萄球菌所占比例分别为28.57%、21.43%、7.14%和19.64%。体温37.3～38.0℃且持续3d以上的病人51例,共培养出13种29株病原菌,尿培养结果显示:大肠埃希菌、铜绿假单胞菌、克雷伯菌、葡萄球菌所占比例分别为20.69%、24.14%、6.90%、27.59%。药敏结果显示,亚胺培南、美罗培南、帕尼培南倍他米隆及头孢哌酮舒巴坦钠、哌拉西林-他唑巴坦等药物对革兰阴性杆菌有较好的药敏结果;替加环素、利奈唑胺、呋喃妥因、替考拉宁、复方磺胺甲唑、万古霉素等药物对革兰阳性球菌有较好的药敏结果。结论 PNL后感染病人菌种分布以革兰阴性杆菌为主,主要致病菌为大肠埃希菌和铜绿假单胞菌,革兰阳性菌以葡萄球菌为主,对不同抗生素的耐药率差异较大。Objective To understand the distribution of pathogenic bacteria and their drug resistance following percutane ous nephrolithotomy （PNL）, so as to provide evidence for post-PNL application of antibiotics. Methods Clinical data of 461 pa tients who underwent PNL, between September 2006 and December 2011, in our department were analyzed retrospectively. For patients with body temperature higher than 38.0 ℃ after PNL, both blood and urine culture were done; for those with temperature between 37.3-38 ℃ and lasted for more than three days, which was considered as postoperative infection, urine culture only was carried out. The positive-culture result was then identified for pathogen and drug resistance. Results There were 64 patients with their temperature higher than 38.0℃ after PNL,78 strains of 18 species of pathogen were cultured. Blood culture indicated： Escherichia coli accounted for 31.8%, pseudomonas aeruginosa for 22.73%, Klebsiella 13.64% and staphylococcus 31.82% ; For patients with temperature ranged 37.5--38.0 ℃ were recorde in 51, urine culture was done and 29 strains of 29 species were recor- ded, of which, the above bacteria accounted for 20.69% ,24.14% ,6.90% and 27.59%, respectively. The results of drug-sentitivi- ty tests were as follows： gram negative bacilli were sensitive to imipenem, meropenem, panipenem/betamipron, cefoperazone and sulbactam /piperacillin sodium; and gram positive coccus were sensitive to tigecycline, linezolid, nitrofurantoin, teicoplanin, com- pound sulfamethoxazole and vancomycin. Conclusion The main pathogen of infection after PNL is gram negative bacteria, mostly escherichia coli and pseudomonas aeruginosa, and staphylococcus was the main type of gram positive bacteria. The differ ences of resistance to different antibiotics are great.

关 键 词：感染 微生物敏感性试验 肾造口术 经皮 

分 类 号：R692.4[医药卫生—泌尿科学]