肝胆外科术后患者腹腔感染耐碳青霉烯类鲍曼不动杆菌临床因素分析  

The clinical factors of abdominal infection with carbapenem-resistant Acinetobacter baumannii in postoperative hepatobiliary patients

作　　者：甘露[1] 邹英[1] 吴昊[2] 李大江[3] 张波[1] 

机构地区：[1]第三军医大学西南医院医院感染管理科,重庆400038 [2]第三军医大学西南医院医教部,重庆400038 [3]第三军医大学西南医院肝胆外科,重庆400038

出　　处：《国际检验医学杂志》2013年第24期3277-3278,共2页International Journal of Laboratory Medicine

基　　金：国家自然科学基金资助项目(71373280)

摘　　要：目的探讨肝胆外科术后患者腹腔感染耐碳青霉烯类鲍曼不动杆菌(CRAB)的相关临床因素,为预防感染提供依据。方法回顾性调查肝胆外科术后患者腹腔感染CRAB的临床资料,对其年龄、手术时间、术中出血量和术后广谱抗菌药物特别是碳青霉烯类的抗菌药物的应用情况进行统计分析。结果肝胆外科术后腹腔感染CRAB的患者中,年龄大于或等于50岁与年龄小于50岁的患者分别为35例(63.64%)和20例(36.36%);手术时间大于或等于4h的患者占69.09%(38例),手术时间小于4h的30.91%(17例);术中出血量大于或等于400mL的患者占72.73%(40例),出血量小于400mL的患者为27.27%(15例);55例患者术后100.00%应用过广谱抗菌药物,其中30例患者应用过碳青霉烯类的抗菌药物,占54.55%,未应用者为45.45%。统计学分析显示,每个临床因素不同分类间比较差异有统计学意义(P<0.05)。结论高龄、手术时间长、术中出血多、术后应用过广谱抗菌药物特别是碳青霉烯类的抗菌药物等因素可能是肝胆外科术后患者腹腔感染CRAB的重要因素,肝胆外科医生应加强关注。Objective To analyze the related factors of the carbapenem-resistant Acinetobacter baumannii with abdominal infec- tion of postoperative patients in the department of hepatobiliary surgery for providing the basis of prevention of its occurrence. Methods We retrospectively reviewed the clinical data of the carbapenem-resistant Acinetobacter baurnannii with abdominal infec- tion of postoperative patients in the department of hepatobiliary surgery for the statistical analysis of the age,operation time, bleed- ing volume during operation and postoperative broad-spectrum antibiotics especially the use of antibiotics in carbapenem. Results The carbapenem-resistant Acinetobacter baumannii with abdominal infection of postoperative patients in the department of hepato- biliary surgery in the distribution of age above 50 years old were 35 cases,accounting for 63.64% ,significantly more than the less than 50 years old 36. 36% ;Operation time more than 4 hours were 38 cases,accounting for 69.09% ,significantly more than 4 hours or less intraoperative blood loss greater than 30.90% ;The amount of bleeding was greater than or equal to 400 mL accounting for 72.73%, significantly more than the less than 27.27 % of 400 mL ;after 55 patients had used broad-spectrum antibiotics, accounting for 100.00 %;Antibacterial drugs, 30 patients used carbapenem accounted for 54.55 %, more than 45.45 % applications. It showed that each dinical factors had a statistically significant difference between the different classification by statistical analysis （P 〈0.05）. Conclusion Old age,operation time,intraoperative bleeding, postoperative broad-spectrum antibiotics especially carbapenem antibiotics eteuhich,may be important factors in carbapenem-resistant Acinetobacterbaumannii with abdominal infection of postop- erative patients in the department of hepatobiliary surgery. Hepatobiliary surgeons should strengthen follow.

关 键 词：肝胆外科 术后腹腔感染 耐碳青霉烯类鲍曼不动杆菌 

分 类 号：R446.5[医药卫生—诊断学]