胃肠肿瘤术后切口感染病原菌监测与预防性抗菌药物的选择分析  

Surveillance of pathogens causing postoperative incision infections in patients with gastrointestinal tumor and selection of prophylactic antibiotics

作　　者：董丹[1] 李佳佳[2] 尚宜星 张晓晓[2] 杜星霖 王豫川[2] 

机构地区：[1]河南科技大学第一附属医院制剂室,河南洛阳471003 [2]河南科技大学第一附属医院门诊药房,河南洛阳471003 [3]河南科技大学第一附属医院住院药房,河南洛阳471003

出　　处：《中华医院感染学杂志》2017年第14期3248-3251,共4页Chinese Journal of Nosocomiology

摘　　要：目的统计分析胃肠肿瘤患者术后切口感染病原菌分布与耐药性监测数据,探讨预防使用抗菌药物的选择,以降低患者术后切口感染,提高手术质量。方法对医院2014年1月-2016年1月行手术治疗的525例胃肠肿瘤患者临床资料进行分析,收集术后切口感染患者的实验室检测、病原菌培养、分离、鉴定及药敏数据,整理分析胃肠肿瘤术后切口感染病原菌的分布情况及主要病原菌对常用抗菌药物的耐药性,结合胃肠肿瘤术患者的临床特点,探讨胃肠道肿瘤术患者围术期预防性抗菌药物的选择方案。结果 525例胃肠道手术患者切口分泌物中36例患者病原菌培养阳性,切口感染率6.86%,36份标本共检出42株病原菌,其中革兰阳性菌32株占76.19%,革兰阴性菌7株占16.67%,真菌3株占7.14%;金黄色葡萄球菌、化脓性链球菌、表皮葡萄球菌对头孢唑林、头孢拉定耐药率>50%,而对替考拉宁、头孢噻吩、头孢氨苄、利奈唑胺、亚胺培南、美罗培南有较高的敏感性;大肠埃希菌、铜绿假单胞菌对替考拉宁、头孢噻吩有较高的耐药率>50%,对氨苄西林、头孢曲松、阿莫西林、亚胺培南、美罗培南敏感性较高;患者经敏感抗菌药物治疗后,感染均得到有效控制。结论定期总结胃肠肿瘤术切口感染病原菌分布及药敏性数据,合理应用抗菌药物,延缓院内病原菌耐药性发展进程,以降低胃肠肿瘤患者术后切口感染率。OBJECTIVE To statistically analyze the distribution and data of surveillance of drug resistance of pathogens causing postoperative incision infections in patients with gastrointestinal tumor and explore the prophylactic use of antibiotics so as to reduce the incidence of postoperative incision infections and improve the surgical quality.METHODS The clinical data of 525 patients with gastrointestinal tumor who received surgical procedures in the hospital from Jan 2014 to Jan 2016 were analyzed,the data of laboratory examinations,culture,isolation,and identification of pathogens as well as drug susceptibility testing were collected from the patients with postoperative incision infections,the distribution of pathogens causing the postoperative incision infections and the drug resistance of the major species of pathogens to the commonly used antibiotics were sorted out and analyzed,and the programs for perioperative use of prophylactic use of antibiotics were explored.RESULTS The incision secretions were cultured positive in 36 of 525patients who received gastrointestinal tract surgery,and the incidence rate of incision infections was 6.86%.Totally 42 strains of pathogens were isolated from 36 specimens,including 32（76.19%）strains of gram-positive bacteria,7（16.67%）strains of gram-negative bacteria,and 3（7.14%）strains of fungi.The drug resistance rates of Staphylococcus aureus,Streptococcus pyogenes,and Staphylococcus epidermidis to cefazolin and cefradine were more than 50%,however,the strains were highly susceptible to teicoplanin,cefalotin,cefalexin,linezolid,imipenem,and meropenem.The drug resistance rates of Escherichia coli and Pseudomonas aeruginosa to teicoplanin and cefalotin were more than 50%,while the strains were highly susceptible to ampicillin,ceftriaxone,amoxicillin,imipenem,and meropenem.The infections were effectively controlled after treatment with sensitive antibiotics.CONCLUSIONIt is necessary to regularly summarize the data of distribution of drug susceptibility of the pathogens caus

关 键 词：胃肠肿瘤术 切口感染 病原菌分布 耐药性检测 预防抗菌药物选择 

分 类 号：R378[医药卫生—病原生物学]