消化道肿瘤结直肠镜手术后感染的病原菌分布特点及耐药性分析  

作　　者：丁旭慧[1] 何春华[1] 

机构地区：[1]嘉兴学院附属第二医院,314000

出　　处：《浙江临床医学》2023年第9期1354-1356,1359,共4页Zhejiang Clinical Medical Journal

基　　金：浙江省医药卫生科技计划项目(2021KY1118)。

摘　　要：目的探讨消化道肿瘤结直肠镜手术后感染的病原菌分布特点与耐药性分析。方法选取2019年1月至2021年12月嘉兴学院附属第二医院接受结直肠镜手术发生术后感染的348例消化道肿瘤患者,对其病原菌培养、鉴定及耐药进行回顾性分析。结果348例消化道肿瘤患者共分离出病原菌450株。其中革兰阴性菌261株(58.0%);革兰阳性菌189株(42.0%)。261株革兰阴性菌中,排名前4位的依次是大肠埃希菌(86株,19.1%)、铜绿假单胞菌(59株,13.1%)、肺炎克雷伯菌(38株,8.4%)、阴沟肠杆菌(35株,7.8%),以上4种菌株对氨苄西林、氨苄西林/舒巴坦、头孢唑林及环丙沙星的耐药率均>50%,对头孢替坦、厄他培南、亚胺培南较敏感(耐药率<25%)。189株革兰阳性菌中,排名前3位的是金黄色葡萄球菌(72株,16.0%)、表皮葡萄球菌(49株,10.8%)、屎肠球菌(41株,9.1%)。以上3种菌株对利奈唑胺、万古霉素、替加环素均敏感(耐药率为0),对青霉素、氨苄西林的耐药率均>60%。结论消化道肿瘤结直肠镜手术后感染的病原菌分布特点主要是大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、阴沟肠杆菌、金黄色葡萄球菌、表皮葡萄球菌、屎肠球菌,临床上可以根据其感染和耐药特点予以经验性用药。Objective To investigate the distribution and drug resistance of pathogens of infection after endoscopic surgery for digestive system tumors.Methods Totally 348 patients with digestive system tumors infected after endoscopic surgery in a hospital from January 1,2019 to December 31,2021 were selected as the research objects.The data of pathogen culture,distribution,and drug resistance of the pathogen were analyzed restrospectively.Results A total of 450 strains of pathogenic bacteria were isolated from 348 patients.Among them,there were 261 strains of Gram-negative bacteria,accounting for 58%;189 strains of Gram-positive bacteria,accounting for 42%.Among the 261 Gram-negative bacteria,the top four strains were Escherichia coli(86 strains,19.1%),Pseudomonas aeruginosa(59 strains,13.1%),Klebsiella pneumoniae(38 strains,8.4%)and Enterobacter cloacae(35 strains,7.8%),and the four strains were resistant to ampicillin,ampicillin/sulbactam,cefazolin and ciprofloxacin,and were sensitive to cefotetan,ertapenem and imipenem(resistance rate<25%).Among the 189 strains of Gram-positive bacteria,the top three were Staphylococcus aureus(72 strains,16.0%),Staphylococcus epidermidis(49 strains,10.8%)and Enterococcus faecium(41 strains,9.1%).The above three strains were all sensitive to linezolid,vancomycin and tegacyclin(with no drug resistance),and the resistance rates to penicillin and ampicillin were more than 60%.Conclusion The pathogens of digestive system tumor patients undergoing endoscopic surgery in our hospital are mainly Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Enterobacter cloacae,Staphylococcus aureus,Staphylococcus epidermidis and Enterococcus faecium.We can give empirically drugs according to the characteristics of infection and drug resistance of them.

关 键 词：消化道肿瘤 结直肠镜手术 病原菌分布 耐药性 

分 类 号：R735[医药卫生—肿瘤] R446.5[医药卫生—临床医学]