直肠癌根治术会阴感染的病原学分析  

Etiological analysis of perineal infections in patients undergoing colorectal cancer resection

作　　者：韩平[1] 厉明秀[1] 马成燕[1] 

机构地区：[1]临沂市人民医院胃肠外科,山东临沂276000

出　　处：《中华医院感染学杂志》2015年第2期396-398,共3页Chinese Journal of Nosocomiology

基　　金：山东省卫生厅基金资助项目(SW-2010B-018)

摘　　要：目的探讨直肠癌根治术会阴切口感染的病原学特点及抗菌药物应用选择,以提高直肠癌根治术会阴切口感染的诊治水平。方法选取直肠癌根治术患者813例,对其中发生切口感染患者取局部分泌物进行细菌培养和药敏试验。结果 813例患者中32例发生会阴部切口感染,发生率为3.94%;共分离出病原菌193株,其中革兰阴性菌147株占76.17%,以大肠埃希菌、肠杆菌属和铜绿假单胞菌为主,革兰阳性菌44株占22.79%,以金黄色葡萄球菌和肠球菌属为主,真菌2株占1.04%;常见革兰阴性菌对美罗培南、阿米卡星、哌拉西林/他唑巴坦和头孢他啶较敏感,敏感率>85.71%,而对氨苄西林、磺胺甲噁唑/甲氧苄啶和庆大霉素敏感性较低,敏感率<55.10%;常见革兰阳性菌对万古霉素、利福平和庆大霉素较敏感,敏感率>86.36%,而对青霉素、克林霉素、磺胺甲噁唑/甲氧苄啶及红霉素敏感性较低,敏感率<52.27%;肠球菌属对阿奇霉素敏感性较高,达100.00%,明显高于其他革兰阳性菌(P<0.05),而对四环素、多西环素敏感性较低,分别为38.46%和61.54%,明显低于其他革兰阳性菌(P<0.05)。结论会阴切口感染率不高,但复合感染常见,临床应早期给予经验性的联合应用,达到广谱抗菌的目的,然后根据药敏结果对用药进行适当调整。OBJECTIVE To explore the etiological characteristics of perineal incision infections in patients undergoing colorectal cancer resection and the use of antibiotics so as to raise the level of diagnosis and treatment of perineal infections in the patients undergoing colorectal cancer resection.METHODS A total of 813 patients who underwent the colorectal cancer resection were enrolled in the study,then the topical wound secretions were collected from the patients with incision infections for bacterial culture,and the drug susceptibility testing was performed.RESULTS The perineal incision infections occurred in 32 of 813patients with the incidence rate of 3.94%.Totally193 strains of pathogens have been isolated,including 147（76.17%）strains of gram-negative bacteria,44（22.79%）strains of gram-positive bacteria,and 2（1.04%）strains of fungi;the Escherichia coli,Enterobacter,and Pseudomonas aeruginosa were the predominant species of gram-negative bacteria;the Staphylococcus aureus and Enterococci were dominant among the gram-positive bacteria.The common gram-negative bacteria were highly susceptible to meropenem,amikacin,piperacillin-tazobactam,and ceftazidime,with the drug susceptibility rate more than 85.71%,while the drug susceptibility rates to ampicillin,sulfamethoxazole-trimethoprim,and gentamicin were less than 55.10%.The common gram-positive bacteria were highly susceptible to vancomycin,rifampicin,and gentamicin,with the drug susceptibility rate more than 86.36%,while the drug susceptibility rates to penicillin,clindamycin,sulfamethoxazole-trimethoprim,and erythromycin were less than 52.27%;the drug susceptibility rate of the Enterococci to azithromycin was as high as 100.00%,significantly higher than that of other species of gram-positive bacteria（P〈0.05）;the drug susceptibility rates of the Enterococci to tetracycline and doxycycline were respectively 38.46% and 61.54%,significantly lower than those of other species of gram-positive bacteria（P〈0.05）.CONCLUSIONThe incidence of the perinea

关 键 词：直肠癌根治术 会阴 切口感染 病原学 抗菌药物 

分 类 号：R619.3[医药卫生—外科学]