胰腺外科手术部位感染与围手术期抗菌药物应用

Surgical Site Infection in Pancreas Surgery and the Use of Perioperative Antibiotics

目的探讨胰腺外科手术部位感染的病原菌特点及围手术期抗菌药物应用。方法回顾性分析我院2001年1月～2005年12月胰腺外科手术后发生的48例手术部位感染患者的病原菌特点及围手术期抗生素的应用情况。结果检出病原菌79株(细菌74株),其中耐甲氧西林金黄色葡萄球菌(MRSA)17株、肠球菌属17株、大肠埃希菌属12株、肠杆菌属5株。三代头孢菌素配伍抗厌氧菌药物是预防用药的主要品种,预防用药平均时间为(4.7±1.2)d;感染多发生在术后第6～14天,中位时间为术后第9天;主要是腹腔感染(39例);抗感染用药以三代头孢菌素配伍抗厌氧菌药物、糖肽类或单用碳青霉烯类为主。结论术后第6～14天为胰腺外科手术部位感染的好发时间;MRSA和肠球菌已经成为胰腺外科手术部位感染的主要病原菌;预防用药及抗感染经验用药的选择应考虑细菌耐药性。

Objective To analyze the pathogen profiles and the use of perioperative antibiotics after surgical site infection （SSI） in pancreas operation. Method We retrospectively analyzed the pathogen profiles and the use of perioperative antibiotics in 48 SSI patients who received pancreas operations from Jan 2001 to Dec 2005. Results Totally 79 strains of pathogens （74 strains of bacteria） were isolated, including 17 strains of methicillin-resistant Staphylococcus aureus （ MRSA）, 17 strains of enterococcus species, 12 strains of Escherichia species, and 5 strains of enterobacteriaceae. Combination of the third generation of cephalosporins and antianaerobic agents were the main prophylactic therapies, with an average duration of （4. 7 ± 1.2） days. Most SSI episodes happened 6 - 14 days postoperatively （ median 9 days）. Celiac infections were most common （ n = 39）. Therapeutic antibiotics gave priority to combined-antibiotics of the third cephalosporins and antianaerobic antibiotics, glycopeptides and carbapenems. Conclusions SSI commonly occurs on the 6-14 postoperative day, with MRSA and enterococci as the common pathogens of SSI after pancreas surgery. Antibiotic resistance should be considered when applying prophylactic therapies.