妇科术后呼吸道感染病原菌药敏分析及临床护理

Drug susceptibility of pathogens causing respiratory tract infections after gynecological surgery and the clinical nursing

目的探讨妇科术后呼吸道感染患者病原菌分布特点、对抗菌药物的药敏率及临床护理在促进患者康复中的作用,降低妇科术后呼吸道感染不良预后的发生率。方法收集2006年1月-2010年12月妇科术后呼吸道感染的1678例患者标本,根据细菌培养以及药敏试验结果分析病原菌分布及对抗菌药物的药敏率;将患者分为妇科术后呼吸道感染特级护理及普通护理组各839例。结果 1678例患者标本中共培养出病原菌1862株,其中革兰阴性菌1609株占86.4%,革兰阳性菌203株占10.9%,真菌50株占2.7%;370株肺炎克雷伯菌中分离出产ESBLs细菌104株,检出率28.1%;铜绿假单胞菌在痰标本中的分离率位于首位,对多数抗菌药敏感性在>60.0%,其中对氨丁卡霉素敏感性最高为82.1%;MRSA对左氧氟沙星及莫西沙星的耐药率较高,约90.0%,对于利福平的耐药率为61.0%;特级护理组患者抗菌药物使用时间、入住ICU时间及术后总的住院时间较普通护理组患者均显著缩短。结论妇科术后呼吸道感染患者病原菌以革兰阴性菌为主,肠杆菌科细菌对于碳青酶烯类药物仍有较好的敏感性,耐甲氧西林金黄色葡萄球菌对喹诺酮类以及青霉素类中多种药物耐药,真菌对多种抗真菌药物均敏感,针对感染患者的特级护理在促进患者康复中作用显著。

OBJECTIVE To investigate the characteristics of distribution and drug resistance of pathogens causing respiratory tract infections in the patients who underwent gynecological operation and to explore the role of clinical nursing in promoting the rehabilitation so as to reduce the incidence of the adverse prognosis after the gynecological operation. METHODS The specimens that were obtained from 1678 cases of patients with respiratory tract infections from Jan 2006 to Dec 2010 were seiected as the study objects. The distribution of bacterial species and the drug susceptibility rates were analyzed based on the bacterial culture and the result of drug susceptibility testing. The patients were divided into the special nursing group and the general nursing group with 839 cases in each. RESULTS Of totally 1862 strains of pathogens isolated from 1678 patients, there were 1609 （86. 4%） strains of gram-negative bacteria, 203 （10.90%） strains of gram-positive bacteria, and 50 （2.7%） strains of fungi. Of 370 strains of Klebsiella pneumoniae, totally 104 strains of ESBLs-producing strains were isolated with the de- tection rate of 28.1 % ; the isolation rate of Pseudomonas aeruginosa from the sputum specimens was the highest, and the drug susceptibility rate to most of antibiotics was more than 60.00%, and the drug susceptibility rate to ammonia dinka neomycin was the highest （82.1%）; the drug resistance rates of MRSA to levofloxacin and moxi- floxacin were about 90. 0%, the drug resistance rate to rifampicin was 61.0%. The time of use of antibiotics, lengthen of ICU stay, and postoperative hospitalization duration were significantly shorter in the special nursing group than in the general nursing group. CONCLUSION The gram-negative bacteria are the predominant pathogens causing respiratory tract infections after the gynecological operation; Enterobacteriaceae remain sensitive to carbapenems antibiotics; MRSA strains are resistant to many quinolones or penicillins antibiotics; the fungi are sensitive to many antifungal agents. The special nursing plays an significant role in promoting the rehabilitation of the patients with infections.