阑尾炎患者术后腹腔脓肿病原学分析  

Etiology of postoperative abdominal abscess appendicitis analysis and prevention countermeasures

作　　者：张若[1] 施孟花[1] 周磊[1] 杜兵[2] 黄和[1] 俞耀军[1] 

机构地区：[1]温州医科大学附属第二医院育英儿童医院胃肠外科,浙江温州325027 [2]温州医科大学附属第二医院育英儿童医院检验科,浙江温州325027

出　　处：《中华医院感染学杂志》2016年第5期1089-1091,共3页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生一般研究计划基金资助项目(2011KYA112)

摘　　要：目的分许阑尾炎患者术后发生腹腔脓肿的病原学特征,并提出预防对策,为临床诊治阑尾炎提供参考依据。方法选取2012年1月-2015年1月入院诊治的阑尾炎术后发生腹腔脓肿患者72例,将其腹腔渗出液进行细菌培养、鉴定及药敏试验,采用VITEK-32微生物全自动分析仪,并根据结果提出相应的预防对策。结果送检72份脓液标本中检出阳性59份,阳性检出率81.94%;单一细菌感染43例占72.88%,两种细菌混合感染15例占25.42%,3种细菌混合感染1例占1.69%;共分离病原菌77株,革兰阴性菌57株占74.03%,革兰阳性菌20株占25.97%,未检出厌氧菌;革兰阴性菌对氨苄西林、氨苄西林/舒巴坦、哌拉西林、头孢噻吩、头布霉素、磺胺甲噁唑/甲氧苄啶的耐药性较高;革兰阳性菌中表皮葡萄球菌的普遍耐药率较高,主要革兰阳性菌对万古霉素均敏感。结论阑尾炎术后发生腹腔脓肿患者病原菌以肠杆菌属为主,尤以大肠埃希菌多见,且耐药性较为严重,临床应结合药敏试验结果合理应用抗菌药物。OBJECTIVE To analyzed the etiological characteristics for abdominal abscess in patients with appendicitis after surgeries and to propose preventive measures so as to provide references for clinical diagnosis and treatments of appendicitis.METHODS From Jan.2012 to Jan.2015,72 patients with appendicitis hospitalized for abdominal abscess were selected.Bacterial culture and identification were conducted to the abdominal percolate.VITEK-32 was explored to make analysis.Preventive measures were proposed correspondingly.RESULTS Totally59 samples proved to be positive and the positive rate was 81.94%.There were 43 cases got infected by single kind of bacteria and the proportion was 72.88%.Moreover,15 cases got infected by two kinds of bacteria accounting for 25.42%and 1case got infected by 3kinds of bacteria,constituting 1.69%.All together 77 strains of pathogens were isolated,including 57 strains of gram-negative bacteria（74.00%）and 20 strains of gram-positive bacteria（25.97%）.No anaerobic bacteria were found.Gram-negative bacteria were highly resistant to ampicillin,ampicillin/sulbactam,piperacillin,cephalothin,tobramycin,and sulfamethoxazole/trimethoprim.Gram-positive bacteria were generally resistant to vancomycin.CONCLUSION Enterobacter,especially Escherichia coli,were common in appendicitis patients with postoperative abdominal abscess and those pathogens are highly resistant to antibiotics.Consequently,antibiotics should be applied rationally according to drug sensitivity test results.

关 键 词：阑尾炎 感染 腹腔脓肿 病原学分析 预防对策 

分 类 号：R656.8[医药卫生—外科学]