医院外科手术患者切口感染病原菌的分布与耐药性  

Species distribution and antimicrobial resistance of pathogenic bacteria causing incision infection in surgical operation

作　　者：杨凯[1] 赵甲[2] 黄华泥 

机构地区：[1]荆州市监利县人民医院神经外科,湖北荆州433300 [2]荆州市监利县人民医院检验科,湖北荆州433300 [3]赤壁市人民医院检验科,湖北赤壁437300

出　　处：《中华医院感染学杂志》2015年第19期4412-4414,共3页Chinese Journal of Nosocomiology

基　　金：湖北省卫生厅基金资助项目(30214078)

摘　　要：目的了解医院外科手术切口感染的病原菌种类及耐药特点,为外科医师预防控制手术切口感染提供参考依据。方法无菌手法采集2011年1月-2013年12月医院外科377例手术切口感染患者的脓性分泌物标本立即送检,病原菌培养和鉴定严格按照WHO规定的临床微生物学检验常规操作技术进行;药敏检测采用K-B法,结果判断依据CLSI当年公示的最新折点,微生物检验全程在室内质量控制前提下进行,数据统计运用WHONET 5.6软件。结果 6 587例外科手术患者发生手术切口感染377例,感染率为5.7%;共分离病原菌407株,其中革兰阴性菌273株占67.1%,革兰阳性菌116株占28.5%,真菌18株占4.4%;检出大肠埃希菌和肺炎克雷伯菌109株,其中产ESBLs 56株,检出率为51.4%,检出耐亚胺培南铜绿假单胞菌20株和鲍氏不动杆菌18株,检出率分别为22.7%和28.3%,检出葡萄球菌属83株,其中MRS 41株,检出率为49.4%;主要革兰阴性菌和革兰阳性菌均对磺胺甲噁唑/甲氧苄啶耐药率高达>60.0%。结论医院领导必须重视外科医院感染管理和细菌耐药性监测工作,预防控制手术切口感染发生率,扭转细菌耐药性快速增长的危险趋势。OBJECTIVE To understand constituent ratio and antimicrobial resistance of pathogenic bacteria causing incision infection in surgical operation so as to provide references for clinical prevention and controlling of it . METHODS The purulent secretion samples from the patients with surgical wound infection from Jan .2011 to Dec . 2013 were collected by sterile technique .Pathogenic bacteria culture and identification were performed in strict ac‐cordance with the clinical microbiology routine operation by the WHO .The susceptibility testing was carried out by K‐B method recommended by CLSI .And the resistance assessments were based on the latest CLSI break‐points .The WHONET 5 .6 version software was used to analyze the data .The microbiological testing was under premise internal quality control .RESULTS Among 6 587 cases with surgical operation ,377 occurred incision infec‐tion （5 .7% ） .Totally 407 pathogenic bacteria were isolated ,and 273 strains （67 .1% ） of them were gram‐negative bacteria ,116 strains （28 .5% ） were gram‐positive bacteria and 18 strains （4 .4% ） were fungi .Totally 109 strains of Escherichia coli and K lebsiella pneumoniae were detected ,including 56 strains of ESBLs‐producing bacteria , accounting for 51 .4% .And 20 strains of imipenem‐resistant Pseudomonas aeruginosa and 18 strains of Acineto‐bacter baumanii were founded ,accounting for 22 .7% and 28 .3% respectively .A total of 83 strains of Staphylo‐coccus were detected ,including 41 strains of MRSA ,holding 49 .4% .The drug resistance rates of main gram‐neg‐ative bacteria and gram‐positive bacteria to sulfamethoxazole/trimethoprim were over 60 .0% .CONCLUSION Hos‐pital leaders must attach importance to the surgical hospital infection control and surveillance of bacterial resist‐ance ,prevent and control the incidence of surgical wound infections to reverse the dangerous trend of rapid growth of bacterial resistance .

关 键 词：外科 手术切口 医院感染 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]