老年食管癌术后食管胃吻合口瘘感染病原菌分布及耐药性  

Distribution and drug resistance of pathogens isolated from elderly esophageal cancer patients with postoperative esophagogastric anastomotic fistula infection

作　　者：李俊艳[1] 刘彩红[1] 徐璐 李福琴[1] LI Jun-yan;LIU Cai-hong;XU Lu;LI Fu-qin(The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450003,China;不详)

机构地区：[1]郑州大学第一附属医院感染管理科,河南郑州450003 [2]河南省儿童医院微生物室,河南郑州450003

出　　处：《中华医院感染学杂志》2022年第6期894-897,共4页Chinese Journal of Nosocomiology

基　　金：中国老年医学学会基金资助项目(GRYJ-LRK2018019)。

摘　　要：目的 分析老年食管癌根治术后食管胃吻合口瘘感染病原菌分布及耐药性。方法 选取郑州大学第一附属医院2019年1月-2020年12月收治的食管癌根治术后食管胃吻合口瘘感染的老年患者144例为研究对象,对患者脓腔引流液进行微生物培养及药敏试验。结果 本研究抗菌药物使用率为92.36%,抗菌药物使用前送检微生物标本138份(送检率95.83%),检出病原菌158株,其中革兰阴性菌占87.34%,革兰阳性菌占6.96%,真菌占5.70%;前3位分离菌分别是铜绿假单胞菌(59株,37.34%)、肺炎克雷伯菌(29株,18.35%)、金黄色葡萄球菌(9株,5.70%)。铜绿假单胞菌对亚胺培南耐药率为6.78%,对头孢吡肟、阿米卡星敏感性较好,耐药率均在10%以下;肺炎克雷伯菌对亚胺培南耐药率为51.72%,对头孢唑林、氨苄西林/舒巴坦在60%以上;金黄色葡萄球菌对苯唑西林的耐药率为22.22%,对万古霉素、利奈唑胺的耐药率为0。结论 食管癌根治术后食管胃吻合口瘘感染老年患者,抗菌药物使用率及使用前微生物标本送检率较高,病原菌以革兰阴性菌为主,耐碳青霉烯类肺炎克雷伯菌分离率较高,定期对病原菌分布及耐药性进行监测分析,为临床最初经验性治疗选用抗菌药物提供依据。OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from elderly esophageal cancer patients with postoperative esophagogastric anastomotic fistula infection. METHODS Totally 144 elderly esophageal cancer patients with postoperative esophagogastric anastomotic fistula infection who were treated in the First Affiliated Hospital of Zhengzhou University from Jan 2019 to Dec 2020 were recruited as the study subjects. Abscess drainage fluid specimens were collected for culture of microorganisms and drug susceptibility testing. RESULTS The utilization rate of antibiotics was 92.36%, and 138 specimens were submitted for culture of microorganisms before the use of antibiotics, with the submission rate 95.83%. A total of 158 strains of pathogens were isolated, 87.34% of which were gram-negative bacteria, 6.96% were gram-positive bacteria, and 5.70% were fungi. Pseudomonas aeruginosa(59 strains, 37.34%), Klebsiella pneumoniae(29 strains, 18.35%) and Staphylococcus aureus(9 strains, 5.70%) ranked the top 3 species of pathogens. The drug resistance rate of the P.aeruginosa to imipenem was 6.78%, and the drug resistance rates to cefepime and amikacin were less than 10%;the drug resistance rate of the K.pneumoniae to imipenem was 51.72%, the drug resistance rates to cefazolin and ampicillin-sulbactam were more than 60%;the drug resistance rate of the S.aureus to oxacillin was 22.22%, and the drug resistance rates to vancomycin and linezolid were 0. CONCLUSION The utilization rate of antibiotics and submission rate of specimens of the elderly esophageal cancer patients with postoperative esophagogastric anastomotic fistula infection are high. The gram-negative bacteria are dominant among the pathogens, the isolation rate of carbapenem-resistant K.pneumoniae is high. It is necessary to regularly monitor and analyze the distribution and drug resistance of the pathogens so as to provide basis for use of antibiotics for the initial empirical treatment.

关 键 词：食管癌 吻合口瘘 感染 病原菌 耐药性 

分 类 号：R735.1[医药卫生—肿瘤]