结肠癌患者术后医院感染病原菌分布及耐药性研究

Distribution and drug resistance of pathogens causing postoperative nosocomial infections in colon cancer patients

目的了解5年结肠癌患者术后医院感染病原菌的分布及其耐药现状,为临床抗菌药物合理选择提供依据。方法对2006年1月-2011年1月医院结肠癌术后患者2435例,采集术后切口感染标本进行培养,并进行鉴定及药敏分析。结果 2435例结肠癌患者中,有133例发生术后切口感染,术后切口感染的发生率为5.46%,对133份感染标本进行检测发现,革兰阳性菌56株占42.11%,前2位为表皮葡萄球菌和金黄色葡萄球菌,分别占18.80%和16.54%;革兰阴性菌77株占57.89%,前2位为大肠埃希菌和肺炎克雷伯菌,分别占21.05%和10.53%;大肠埃希菌对亚胺培南、阿米卡星及哌拉西林/他唑巴坦的敏感性最高,产ESBLs率高达64.29%;葡萄球菌属中耐碱氧西林表皮葡萄球菌和耐甲氧西林金黄色葡萄球菌检出率分别为84.00%和68.18%,未发现对万古霉素和利奈唑胺中介或耐药的葡萄球菌。结论结肠癌患者术后医院感染病原菌种类繁多,耐药性强,加强耐药监测对合理应用抗菌药物有重要指导意义。

OBJECTIVE To investigate the distribution and drug resistance of the pathogenic bacteria isolated from the colon cancer patients in the 5 years so as to provide basis for reasonable use of antibiotics.METHODS The bacteria isolated from 2435 colon cancer patients with postoperative nosocomial infections in the hospital from 2006 to 2011 were identified,and their sensitivities to antibiotics were tested and analyzed.RESULTS Of 2435 colon cancer patients,133 patients had postoperative infections,the incidence of postoperative infection rate was 5.46%.The detection of 133 infected specimens found that there were totally 56（42.11%） strains of gram-positive bacteria and 77（57.89%） of gram-negative bacteria,Staphylococcus epidermidis（18.80%） and Staphylococcus aureus（16.54%）were the top two species of gram-positive bacteria,and Escherichia coli（21.05%）and Klebsiella pneumoniae（10.53%） were the top two gram-negative bacteria;the drug resistance rates of E.coli strains to imipenem,amikacin,and piperacillin/tazobactam were the highest,the isolation rate of the ESBLs-producing strains was 64.29%.The detection rates of methicillin-resistant S.aureus（MRSA） and S.epidermidis（MRSE） were 68.18% and 84.00%,respectively,there were no vancomycin and linezolid-resistant or intermediate isolates detected.CONCLUSION There are a varieties of pathogens causing postoperative infections in the colon cancer patients,the drug resistance is serious,thus it is of great significance in guiding the reasonable use of antibiotics to intensify the monitoring of drug resistance.