胆囊切除术后手术部位感染病原菌的分布与耐药性分析  

Distribution and resistance of pathogenic bacteria in different surgical sites after cholecystectomy

作　　者：张波[1] 滕华安 董家刚[2] 董建明[1] 李雯[3] 

机构地区：[1]宜宾市第三人民医院药剂科,四川宜宾644000 [2]宜宾市第三人民医院肝胆外科,四川宜宾644000 [3]宜宾市第一人民医院药剂科,四川宜宾644000

出　　处：《中华医院感染学杂志》2017年第18期4195-4197,4205,共4页Chinese Journal of Nosocomiology

基　　金：宜宾市重点科技计划基金资助项目(2014YZY003)

摘　　要：目的探讨胆囊切除患者术后医院感染病原菌分布及其耐药性。方法选取2014年3月-2017年3月肝胆外科1815例行胆囊切除术患者为研究对象,其中行开腹胆囊切除术712例,行腹腔镜胆囊切除术1103例,分析不同手术方式术后医院感染情况和术后不同感染部位病原菌分布及其耐药性。结果 1815例胆囊切除术患者术后发生医院感染109例,感染率为6.0%,其中开腹胆囊切除术患者术后感染47例,感染率为8.7%,显著高于腹腔镜胆囊切除术患者(χ~2=15.16,P<0.01);109例术后感染患者中浅表手术切口感染率明显高于深部手术切口感染及脏器或腔隙感染率;感染患者病原菌送检标本共分离出109株病原菌,其中革兰阳性菌41株占37.6%,革兰阴性菌57株占52.3%,其他菌11株占10.1%;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁的耐药率较低,革兰阴性菌对亚胺培南、美罗培南、阿米卡星、妥布霉素的耐药率较低。结论为有效降低胆囊切除术后医院感染率及细菌耐药率,术前应及时采取预防措施,术中应严格无菌操作,术后应根据药敏试验结果合理选用抗菌药物。OBJECTIVE To explore the distribution and drug resistance of pathogens causing postoperative nosocomial infections in patients after cholecysteceomy.METHODS A total of 1815 patients who underwent the cholecystectomy in the departement of hepatobiliary surgery from Mar.2014 to Mar.2017 were enrolled in the study,including 712 cases of patients with open cholecystectomy and 1103 cases of patients with laparoscopic cholecystectomy.The distribution of pathogenic bacteria and the drug resistance of different surgical methods and different sites were analyzed.RESULTS Totally 109 cases of postoperative nosocomial infection occurred in patients with cholecystectomy,and the infection rate was 6.0% .Among them,47 cases were open cholecystectomy,with the infection rate of 8.7% ,which was significantly higher than that of postoperative infections in patients with laparoscopic cholecystectomy（χ^2=15.16,P〈0.01）.The infection rate of superficial incision infections in 109 cases of postoperative nosocomial infection was significantly higher than that of deep surgical incision infection and viscera or lacunar infection.A total of 109 pathogens were isolated from specimens of infected patient.Among them,41 strains were gram-positive bacteria,accounting for 37.6% ,57 strains were gram-negative bacteria,accounting for52.3% ,and 11 strains were other bacteria,accounting for 10.1% .The resistant rates of gram-positive bacteria to vancomycin,linazolamide and teicoplanin were low,and the resistant rates of gram-negative bacteria to imipenem,meropein,amikacin and tobramycin were low.CONCLUSIONIn order to effectively reduce the incidence of nosocomial infection and bacterial resistance after cholecystectomy,preventive measures should be taken before operation,aseptic operation should be strictly performed during the operation,and antimicrobial agents should be rationally selected according to the results of drug susceptibility test.

关 键 词：胆囊切除术 医院感染 病原菌 耐药性 

分 类 号：R619.3[医药卫生—外科学]