耳显微术后医院感染的临床分析与抗菌药物治疗  

Clinical characteristics of postoperative nosocomial infections in patients undergoing ear microsurgery and antibiotics therapy

作　　者：刘艳锋[1] 姜顺明[1] 蒋骅[2] 王勤瑛[3] 谢鼎骏 汪红明[1] 

机构地区：[1]浙江大学医学院附属二院建德分院耳鼻咽喉头颈外科,浙江建德311600 [2]浙江大学医学院附属二院耳鼻咽喉头颈外科,浙江杭州311000 [3]浙江大学医学院附属一院耳鼻咽喉头颈外科,浙江杭州311000

出　　处：《中华医院感染学杂志》2015年第17期3938-3940,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅医药卫生科技基金资助项目(2012KYB100)

摘　　要：目的探讨杭州地区多中心耳显微术后医院感染的临床特点及抗菌药物治疗方法,为临床诊治提供参考。方法选取耳显微手术患者2 864例(3 781耳),回顾性分析其中发生术后医院感染的79例患者的临床资料,对其感染部位及临床特点进行总结;取感染部位体液进行病原菌培养和药敏试验。结果 79例感染患者中手术局部感染51例占64.56%,肺部感染21例占26.58%,泌尿系感染7例占8.86%;共检出病原菌92株,其中革兰阳性菌53株占57.61%,革兰阴性菌38株占41.30%,真菌1株占1.09%;以金黄色葡萄球菌、粪肠球菌为代表的革兰阳性菌对万古霉素和替考拉宁敏感性较高,以阴沟肠杆菌和铜绿假单胞菌为代表的革兰阴性菌对亚胺培南、环丙沙星、头孢吡肟、美罗培南敏感性较高。结论引起耳显微术后医院感染的病原菌多样,不同病原菌对抗菌药物的敏感性存在着较大差异,在感染早期未明确致病菌种类时,通过抗菌药物联合应用可以获得良好的治疗效果。OBJECTIVE To explore the clinical characteristics of postoperative nosocomial infections in the patients undergoing ear microsurgery in Hangzhou area and observe the antibiotics therapy so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 2 864patients（3 781ears）who underwent the ear microsurgery were enrolled in the study,then the clinical data of 79 patients with the postoperative nosocomial infections were retrospectively analyzed,the infection sites and clinical characteristics were observed,the body fluid specimens were collected from the infections sites for the culture of pathogens,and the drug susceptibility testing was performed.RESULTS Of the 79 patients with infections,51（64.56%）had the surgical local infections,21（26.58%）had the pulmonary infections,and 7（8.86%）had the urinary system infections.Totally 92 strains of pathogens were isolated,including 53（57.61%）strains of gram-positive bacteria,38（41.30%）strains of gramnegative bacteria,and 1（1.09%）strain of fungus.Staphylococcus aureus and Enterococcus faecalis were the predominant species of the gram-positive bacteria and were highly susceptible to vancomycin and teicoplanin.Enterobacter cloacae and Pseudomonas aeruginosa were dominant among the gram-negative bacteria and were highly susceptible to imipenem,ciprofloxacin,cefepime,and meropenem.CONCLUSIONThe pathogens causing the postoperative nosocomial infections in the patients undergoing the ear microsurgery are diversified and vary significantly in the drug susceptibility.The combination use of antibiotics can achieve good therapeutic effect in the early stage during which the species of the pathogens causing the infections are unknown.

关 键 词：耳显微手术 医院感染 临床特征 抗菌治疗 

分 类 号：R978.1[医药卫生—药品]