剖宫产术切口感染的病原学分析及耐药性监测

Etiological analysis of incision infections after cesarean section and monitoring of drug resistance

目的研究分析剖官产术后切口感染的致病菌及其耐药性，探讨临床用药对策，以降低感染率。方法选取2010年1月-2012年1月入院进行剖宫产术并发切口感染的患者132例，取患者切口部位脓液或分泌物，并严格按照《全国临床检验操作规程》进行病原菌培养、分离、鉴定，共分离出150株病原菌，将所有菌株进行药敏试验，检测其耐药性，并分析临床合理用药方法。结果共检出病原菌150株，其中革兰阳性菌58株占38．66％，革兰阴性菌92株占61．34％，排名前3位的病原菌依次为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌，分别占28．67％、23．33％、18．67％；大肠埃希菌对氨苄西林的耐药率高达93．02％，对头孢唑林、头孢呋辛、环丙沙星、氨曲南的耐药率普遍〉50．00％，铜绿假单胞菌对阿米卡星、头孢哌酮／舒巴坦、亚胺培南、美罗培南的耐药率〈30．00％，万古霉素与替考拉宁对革兰阳性菌的耐药率为0，金黄色葡萄球菌对青霉素、氨苄西林、磺胺甲嗯唑／甲氧苄啶的耐药率均为85．71％，粪肠球菌耐药率普遍在30．00％～50．00％。结论剖宫产切口感染以革兰阴性菌，尤其大肠埃希菌为主，并且致病菌对常用抗菌药物的多药耐药性较为严重，临床应合理应用抗菌药物。

OBJECTIVE To observe the distribution and drug resistance of pathogenic bacteria causing incision infec- tions after cesarean section and explore countermeasures for clinical medication so as to reduce the infection rate. METHODS A total of 132 patients with incision infections, who underwent the cesarean section in the hospital from Jan 2010 to Jan 2012, were enrolled in the study, then the pus or secretions was sampled from the incision sites, the culture, isolation, and identification of the pathogenic bacteria were performed by strictly referring to the national clinical laboratory test procedures% totally 150 strains of pathogens have been isolated, the drug sus- ceptibility testing for all the strains was performed, and the measures for reasonable clinical medication were ana- lyzed. RESULTS Totally 150 strains of pathogens have been isolated, including 58 （38.66%） strains of gram-posi- tive bacteria and 92 （61.34 % ） strains of gram-negative bacteria; the Escherichia coli, Staphylococcus aureus, and Pseudomonasaeruginosa ranked the top three species, accounting for 28.67%, 23.33%, and 18.67%, respec- tively. The drug resistance rate of the E. coli to ampicillin was up to 93.02%, while the drug resistance rates to ce- fazolin, cefuroxime, ciprofloxacin, and aztreonam were more than 50.0% the drug resistance rates of the P. aeruginosa to amikacin, cefoperazone-sulbactam, imipenem, and meropenem were less than 30.0% the drug re- sistance rates of the gram-positive bacteria to vaneomycin and teicoplanin were 0% the drug resistance rates of the S. aureus to penicillin, ampicillin, and sulfamethoxazole-trimethoprim were 85.71% the drug re＇sistance rate of the Enterococcus faecalis varied between 30% and 50%. CONCLUSION The gram-negative bacteria are the main pathogens causing incision infections in the patients undergoing cesarean section, the pathogenic bacteria are highly multidrug-resistant to the commonly used antibiotics, and the antibiotics should be reasonably used.