宫颈癌患者术后感染病原菌及耐药性分析

Pathogens causing postoperative infections in cervical cancer patients and analysis of drug resistance

目的了解宫颈癌患者术后感染病原菌及对常用抗菌药物的耐药性,为临床治疗宫颈癌时合理用药提供参考。方法以2009年1月-2012年8月在医院进行宫颈癌手术并发生术后感染的113例患者为研究对象,取患者宫颈分泌物进行细菌培养和鉴定,采用纸片法(K-B法)进行药敏试验。结果 1678例宫颈癌手术患者发生术后感染113例,感染率为6.73%,感染部位以手术切口为主,占49.35%,其次为泌尿道和盆腔,分别占23.38%和20.12%;113例宫颈癌术后感染患者共分离出154株病原菌,以革兰阴性菌为主占63.64%;其次为革兰阳性菌和真菌,分别占29.87%和6.49%;革兰阴性菌中大肠埃希菌对氨苄西林和哌拉西林的耐药率较高,为97.67%及93.02%,肺炎克雷伯菌对氨苄西林和哌拉西林的耐药率为85.00%和75.00%,铜绿假单胞菌对阿米卡星的耐药率最高为70.59%,主要革兰阴性菌对头孢吡肟、亚胺培南较敏感,耐药率<33.00%。结论宫颈癌患者术后感染病原菌种类复杂,细菌耐药性较强,临床治疗时应该根据药敏试验结果合理选择抗菌药物,并动态监测其耐药性变化。

OBJECTIVE To understand the pathogens causing postoperative infections in cervical cancer patients and analyze the drug resistance to commonly used antibiotics so as to guide the reasonable medication for the clinical treatment of cervical cancer.METHODS A total of 113 cervical cancer patients who underwent cervical cancer surgery in the hospital from Jan 2009 to Aug 2012 were enrolled in the study,then the cervical secretions were sampled for the bacterial culture and identification,and the drug susceptibility testing was performed by K-B method.RESULTS Of totally 1678 cases of cervical cancer surgery patients,the postoperative infections occurred in 113 cases with the incidence rate of 6.73%;the patients with surgical incision infections accounted for 49.35%,the patients with urinary tract infections 23.38%,and the patients with pelvic infections 20.12%.Of the 113 patients with postoperative infections,totally 154 strains of pathogens were isolated,the gram-negative bacteria were dominant（63.64%）,followed by the gram-positive bacteria（29.87%）and the fungi（6.49%）.The drug resistance rates of the gram-negative bacteria to ampicillin and piperacillin were 97.67% and 93.02%,respectively;the drug resistance rates of the Klebsiella pneumoniae to ampicillin and piperacillin were 85.00% and 75.00%,respectively;the drug resistance rate of the Pseudomonas aeruginosato amikacin was the highest（70.59%）;the drug resistance rates of the main gram-negative bacteria to cefepime and imipenem were less than 33.00%.CONCLUSIONThe species of the pathogens causing postoperative infections in the cervical cancer patients are complex and highly drug resistant,thus it is necessary for the hospital to reasonably use antibiotics based on the result of drug susceptibility testing and dynamically monitor the change of drug resistance.