肿瘤患者手术部位感染病原学分析及抗菌药物应用

Etiological analysis of surgical site infections in tumor patients and use of antibiotics

目的探讨普通外科肿瘤患者手术后手术部位发生感染的病原学特点及其耐药性,为临床提高肿瘤患者术后手术部位感染的诊治水平提供资料。方法选取204例普外科肿瘤手术后手术部位发生感染的患者,取感染部位的炎性渗出物、深部穿刺液、引流液及坏死组织进行细菌培养和耐药性分析。结果 204例普外科肿瘤手术后手术部位感染患者共检出病原菌259株,其中革兰阴性菌180株占69.50%,革兰阳性菌69株占26.64%,真菌10株占3.86%,排名前5位病原菌为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌,分别占30.50、13.90%、10.42%、8.49%、8.11%;革兰阴性菌对氨苄西林、头孢唑林、头孢曲松的耐药性普遍较高,而普遍对头孢哌酮联合舒巴坦治疗敏感性较高,大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对于亚胺培南和美罗培南均有较高的敏感性;革兰阳性菌均对万古霉素表现出了高度的敏感性同时对呋喃妥因也具有较高的敏感性。结论手术切口感染的病原菌较为复杂,在临床工作中应加强预防,一旦出现感染应及时进行细菌培养和药敏试验,合理应用抗菌药物。

OBJECTIVE To investigate the etiological characteristics of postoperative surgical site infections in thetumor patients of general surgery department and analyze the drug resistance so as to guide the clinical diagnosisand treatment of the postoperative surgical site infections. METHODS Totally 204 cases of tumor patients withpostoperative surgical site.infections were selected from the general surgery department, then the inflammatory ex-udates from the infection sites,deep puncture fluid,drainage fluid,and necrotic tissue were sampled for the bacte-rial culture, the drug resistance was analyzed. RESULTS Of 204 cases of tumor patients with postoperative surgicalsite infections investigated, totally 259 strains of pathogens were isolated, including 180 （69. 50%） strains ofgram-negative bacteria,69 （26. 64%） strains of gram-positive bacteria,and 10 （3. 86%） strains of fungi. TheEscherichia coli,Staphylococcus aureus ’ Klebsiella pneumoniae y Pseudomonas aeruginosa,and Enterobacter cloacae ranked the top 5 species of the pathogens, accounting for 30. 50% ,13. 90% , 10. 42%,8, 49%,and 8.11%,respectively. The gram-negative bacteria were highly resistant to ampicillin, cefazolin, and ceftriaxone and werehighly susceptible to cefoperazone combined with sulbactam. E. coli, K. pneumoniae,and P. aeruginosa werehighly susceptible to imipenem and meropenem; the gram-positive bacteria were highly susceptible to vancomycinas well as nitrofurantoin. CONCLUSION The pathogens causing the surgical site infections are complex,it is necessary for the hospital to strengthen the prevention, once the infections occur,the bacterial culture and the drug susceptibility testing should be performed,and the antibiotics should be reasonably used.