胰腺癌患者根治性切除术后腹腔感染的病原菌分析研究  

Analysis of pathogens causing postoperative abdominal infections in pancreatic cancer patients undergoing radical resection

作　　者：崔世昌[1] 王维山[1] 史宪杰[2] 何蕾[2] 梁雨荣[2] 陈明易[2] 王宏光[2] 孙启栋[1] 

机构地区：[1]临沂市沂水中心医院普外二科,山东临沂276400 [2]解放军总医院肝胆外科,北京100853

出　　处：《中华医院感染学杂志》2016年第6期1289-1291,共3页Chinese Journal of Nosocomiology

基　　金：全军医学科研"十二五"基金资助项目(CWS11J096)

摘　　要：目的探讨胰腺癌根治性切除术后腹腔感染的病原菌分布与耐药性特点,为临床治疗提供依据。方法回顾性分析解放军总医院2009年1月-2013年12月318例胰腺癌行根治性切除手术患者的临床资料,分析其术后腹腔感染的病原学特点与耐药性;采用SPSS 13.0软件进行统计分析。结果术后共发生腹腔感染42例,感染率为13.2%;引流液中分离出病原菌76株,其中革兰阴性菌占57.9%,革兰阳性菌占35.5%,真菌占6.6%;铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌对亚胺培南较为敏感,耐药率分别为7.7%、0和8.3%,屎肠球菌、金黄色葡萄球菌对替考拉宁和万古霉素较为敏感,耐药率分别为9.1%、9.1%和10.0%、0;白色假丝酵母菌对氟康唑和伏立康唑均敏感。结论腹腔感染是胰腺癌根治性切除术后常见的并发症,减少术中污染和术后通畅引流是其预防的有效措施,根据引流液培养结果应用合理抗菌药物是其治疗的关键。OBJECTIVE To explore the distribution and drug resistance of pathogens causing postoperative abdominal infections in pancreatic cancer patients undergoing radical resection so as to provide guidance for clinical treatment.METHODS The clinical data of 318 pancreatic cancer patients who underwent the radical resection in PLA General Hospital from Jan 2009 to Dec 2013 were retrospectively analyzed,the etiological characteristics of the postoperative abdominal infections and drug resistance were observed,and the statistical analysis was performed with the use of SPSS 13.0software.RESULTS A total of 42 patients had the postoperative abdominal infections with the infection rate of 13.2%.Totally 76 strains of pathogens were isolated from drainage fluid,of which57.9% were gram-negative bacteria,35.5% were gram-positive bacteria,and 6.6% were fungi.The drug resistance rates of Pseudomonas aeruginosa,Escherichia coli,and Klebsiella pneumoniae to imipenem were 7.7%,0,and 8.3%,respectively.The drug resistance rates of Enterococcus faecium to teicoplanin and vancomycin were9.1% and 9.1%,respectively;the drug resistance rates of Staphylococcus aureus to teicoplanin and vancomycin were 10.0%and 0,respectively.Candida albicans was susceptible to fluconazole and voriconazole.CONCLUSION The postoperative abdominal infection is a common complication in the pancreatic cancer patients undergoing the radical resection.It is an effective way to reduce the intraoperative contamination and conduct the postoperative drainage so as to prevent the infections and is the key for the treatment to reasonably use antibiotics based on the results of culture of drainage fluid.

关 键 词：腺癌 腹腔感染 病原菌 耐药性 

分 类 号：R657.5[医药卫生—外科学]