妇科腹腔镜手术切口感染病原菌分布及耐药性分析  

Distribution and antimicrobial resistance of pathogens causing incision infections in gynecological patients undergoing laparoscopic surgery

作　　者：王晨笛[1] 罗宇鹏[1] 黎明[2] 朱厚宏[2] 李莉[1] 

机构地区：[1]成都市第五人民医院妇产科,四川成都611130 [2]成都市疾病预防控制中心微生物室,四川成都610041

出　　处：《中华医院感染学杂志》2013年第11期2754-2756,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨妇科腹腔镜手术切口感染的病原菌分布及耐药性,为妇科临床用药提供参考。方法回顾性分析2009年1月-2011年12月125例妇科腹腔镜手术切口感染病例的病原菌分布及耐药性。结果腹腔镜辅助阴式手术切口感染率最高,为8.77%,与其他两组术式比较,差异有统计学意义(P<0.05);从106份标本中共分离出病原菌83株,其中革兰阴性杆菌55株占66.27%,革兰阳性球菌26株占31.33%,真菌2株占2.41%;革兰阴性杆菌对亚胺培南保持较高的敏感性,葡萄球菌属和肠球菌属对万古霉素均敏感;检出产超广谱β-内酰胺酶(ESBLs)大肠埃希菌及肺炎克雷伯菌24株,检出率70.59%;检出耐甲氧西林金黄色葡萄球菌(MRSA)及凝固酶阴性葡萄球菌(MRCNS)10株,检出率83.33%。结论妇科腹腔镜手术经阴式的操作环节加大了手术切口感染风险;腹腔镜手术切口感染病原菌分布广泛,主要菌株具有多药耐药性,应重视细菌学培养,根据药敏试验结果指导临床合理用药。OBJECTIVE To investigate the distribution of pathogens causing incision infections in gynecological patients undergoing laparoscopic operation and their resistance to antibiotics so as to offer the basis for the use of antibiotics in department of gynecology. METHODS The distribution and drug resistance of the pathogens causing incision infections in 125 patients undergoing laparoscopic surgery from Jan, 2009 to Dec, 2011 were retrospectively analyzed. RESULTS The rate of incision infections in laparoscopically assisted vagniai operation was the highest （8.77%） compared with the other two methods, and there was significant statistical difference （P〈0. 05）. Totally 83 pathogen strains were cultured from 106 secretions, of which the gram-negative bacilli, gram-positive cocci and fungi accounted for 66.27%, 31.33% and 2.41%, respectively. Imipenem had better activity for gram-negative bacilli, however, vaneomycin had better activity for Staphylococcus and Enterococcus. 24 （70. 59%） strains of ESBLs-producing Escherichia coli and Klebsiella pneumoniae and 10 （83.33%） strains of MRSA and MRCNS were detected. CONCLUSION The laparoscopically assisted vagnial operation in gynecological patients have a greater risk of incision infection. The pathogenic bacteria are widely distributed, some of which have multi- drug resistance. The clinicians should pay attention to the bacterial cuiture and use drugs more reasonably.

关 键 词：腹腔镜手术 切口感染 病原菌 耐药率 

分 类 号：R378[医药卫生—病原生物学]