胃癌根治术后下呼吸道感染病原菌耐药性及危险因素分析  

Drug resistance of pathogens causing lower respiratory tract infections after radical gastrectomy and analysis of risk factors

作　　者：袁博[1] 刘保荣[1] 慕为民[1] 徐心[2] 

机构地区：[1]西安市中心医院普外二科,陕西西安710003 [2]西安交通大学第二附属医院普通外科,陕西西安710003

出　　处：《中华医院感染学杂志》2014年第1期67-69,共3页Chinese Journal of Nosocomiology

基　　金：陕西省科技攻关计划基金项目(2010k14-0220)

摘　　要：目的探讨胃癌根治术后下呼吸道感染病原菌分布及耐药性,并对感染的危险因素进行筛选、分析。方法选择431例接受手术治疗的胃癌患者中发生术后下呼吸道感染的93例患者作为研究对象,对呼吸道分泌物进行细菌培养并进行药敏试验;分别采用单因素χ2检验及多因素logistic回归分析对发生感染的危险因素进行筛选与确定。结果 431例患者后发生下呼吸道感染者93例,感染率21.58%;共分离出病原菌179株,其中革兰阳性菌112株占62.57%,以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌为主,革兰阴性菌67株占37.43%,以表皮葡萄球菌、溶血链球菌、金黄色葡萄球菌为主;革兰阴性菌对亚胺培南最为敏感,其中肺炎克雷伯菌耐药率仅为2.44%,表皮葡萄球菌对三代头孢菌素较为敏感,未发现耐万古霉素革兰阳性菌;年龄≥60岁、合并营养不良、合并糖尿病、手术时间≥3h、卧床时间≥4d、留置胃管时间≥3d的患者、联合胰体尾及脾切除是胃癌术后发生感染的独立危险因素(P<0.05)。结论在处理胃癌术后感染时,除根据药敏试验选择合适抗菌药物外,还应根据危险因素进行一定的临床干预。OBJECTIVE To explore the distribution and drug resistance of pathogens causing lower respiratory tract infections after radical gastrectomy and observe the risk factors for the infections.METHODS Totally 431 patients who underwent radical gastrectomy were enrolled in the study,among which 93patients with postoperative lower respiratory tract infections were chosen as the study objects,then the bacterial culture of the respiratory tract secretions was carried out,the drug susceptibility testing was performed;the univariate chi-square test and the multivariate logistic regression analysis were performed to screen out and determine the risk factors for the infections. RESULTS Of totally the 431 patients,the lower respiratory tract infections occurred in 93cases with the infection rate of 21.58%.A total of 179 strains of pathogens have been isolated,including 112（62.57%）strains of grampositive bacteria and 67（37.43%）strains of gram-negative bacteria;the Klebsiella pneumoniae,Pseudomonas aeruginosa,and Escherichia coli were dominant among the gram-positive bacteria;the Staphylococcus epidermidis,Streptococcus hemolysis,and Staphylococcus aureus were the predominant species of gram-negative bacteria. The gram-negative bacteria were most susceptible to imipenem,the drug resistance rate of the K.pneumoniae was only 2.44%,the S.epidermidis was highly susceptible to the third generation cephalosporins;no vancomycin-resistant gram-positive bacteria have been detected.The more than 60years of age,complication of malnutrition, complication of diabetes,operation duration more than 3hours,bedridden time more than 4days,gastric tube indwelling time more than 3days,and combination with distal pancreatectomy and splenectomy were the independent risk factors for the infections after the radical gastrectomy（P0.05）.CONCLUSIONIn addition to the reasonable use of antibiotics based on the result of drug susceptibility testing,the clinical interventions should be taken according to the risk factors for the infections after ra

关 键 词：胃癌 感染 病原菌 耐药性 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]