胆道结石术后医院感染病原菌及相关影响因素分析  

Distribution of pathogens causing postoperative nosocomial infections in patients with cholelithiasis and related influencing factors

作　　者：丁孟德 陈中朝 王林俊 胡琦嵘 高东升 

机构地区：[1]永康市第一人民医院外一科,浙江永康321300

出　　处：《中华医院感染学杂志》2018年第1期84-87,共4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(2014KYB297)

摘　　要：目的分析胆道结石术后患者医院感染病原菌分布特点及相关影响因素,旨在为临床用药提供一定参考。方法选取医院2012年12月-2016年12月接受胆道结石手术患者950例,分析术后医院感染情况,感染病原菌特点及耐药性,对影响医院感染的相关因素进行单因素及多因素非条件Logistic回归分析。结果 950例胆道结石患者术后发生医院感染48例,感染率为5.05%;48例医院感染患者,共分离出病原菌46株,其中革兰阴性菌29株占63.04%;革兰阳性菌15株占32.61%,真菌2株占4.35%;革兰阴性菌中大肠埃希菌对环丙沙星和左氧氟沙星耐药率较高,分别为91.67%和83.33%;肺炎克雷伯菌对环丙沙星和庆大霉素耐药率较高,分别为90.91%和81.82%;金黄色葡萄球菌对红霉素、青霉素G和氨苄西林耐药率较高,分别为100.00%、85.71%、85.71%;溶血性葡萄球菌对青霉素G、红霉素和氨苄西林耐药率较高,分别为100.00%、83.33%、83.33%;非条件Logistic回归分析结果表明,年龄、吸烟、饮酒、住院时间为胆道结石患者术后医院感染的独立影响因素。结论胆道结石患者术后医院感染病原菌以革兰阴性菌为主,年龄、吸烟、饮酒、住院时间为胆道结石患者术后医院感染的影响因素,临床应根据上述特征进行针对性干预治疗。OBJECTIVE To investigate the distribution of pathogens causing postoperative nosocomial infections in patients with cholelithiasis and analyze the related influencing factors so as to provide guidance for clinical use of antibiotics.METHODS A total of 950 patients who received biliary stones surgery in the hospital from Dec 2012 to Dec 2016 were enrolled in the study, the prevalence of postoperative nosocomial infections was analyzed, the dis- tribution and drug resistance of pathogens causing the infections were observed, and the univariate analysis and non-conditional multivariate logistic regression analysis were performed for the influencing factors for the nosoco- mial infections.RESULTS Of the 950 patients with cholelithiasis, 48 had postoperative nosocomial infections, with the infection rate 5.05 %.Totally 46 strains of pathogens were isolated from the 48 patients with nosocomial infec- tions, of which 29 （63.04%） were gram-negative bacteria, 15 （32.61%） were gram-positive bacteria, and 2 （45.35%） were fungi.Among the gram-negative bacteria, the drug resistance rates of Escherichia coli strains to ciprofloxacin and levofloxacin were 91.67 % and 83.33 %, respectively; the drug resistance of Klebsiella pneurnon- iae straisn to ciprofloxacin and gentamicin were 90.91% and 81.82%, respectively. The drug resistance rates of Staphylococcus aureus strains to erythromycin, penicillin G and ampicllin were 100.00 %, 85.710% and 85.71%, respectively; the drug resistance rates of Staphylococcus haemolyticus strains to penicllin G, erythromycin and ampicllin were 100.00%, 83.33% and 83.33%, respectively.The non-conditional logistic regression analysis indi- cated that the age, smoking, drinking and length of hospital stay were the independent risk factors for the postop-erative nosocomial infections in the patients with cholelithiasis.CONCLUSION The gram-negative bacteria are dom- inant among the pathogens causing the postoperative nosocomial infections in the patients with cholelithiasis.The age, smoking,

关 键 词：胆道结石 医院感染 病原菌 影响因素 

分 类 号：R378[医药卫生—病原生物学]