胃癌根治术后腹腔感染的病原学分析

Etiological analysis on postoperative intra-abdominal infection after radical gastrectomy

目的对胃癌患者行根治性切除术后腹腔感染的病原学特征进行回顾性分析。方法回顾性分析479例胃癌患者根治术后腹腔感染的病原学种类及药敏结果。结果 479例患者中32例术后出现腹腔感染(6.68%),病原学阳性者27例,阳性率为84.38%。检出病原菌32株,其中革兰阴性菌24株(75.00%),包括大肠埃希菌15株(46.86%),肺炎克雷伯菌3株(9.38%),普通变形杆菌、奇异变形杆菌、阴沟肠杆菌、普城沙雷菌、不动杆菌及铜绿假单胞菌各1株(各占3.13%);革兰阳性菌7株(21.88%),包括粪肠球菌4株(12.50%),耐久肠球菌、金黄色葡萄球菌及溶血性葡萄球菌各1株(3.13%);真菌1株(3.13%)。药敏结果显示32株病原菌中,对常用抗菌药物的耐药率较高,其中革兰阴性菌对美洛培南敏感性最高(91.67%),而革兰阳性菌对万古霉素最为敏感(85.71%)。结论大肠埃希菌、粪肠球菌、肺炎克雷伯菌是胃癌患者根治术后腹腔感染最主要的致病菌,临床上应注意合理使用抗菌药物。

Objective To analyze the epidemiology characteristics of bacteria in postoperative intra-abdominal infection after radical gastrectomy, retrospectively. Methods Data of 479 patients undergoing radical gastrectomy were collected. The species of the pathogens responsible for postoperative intra-abdominal infection and the result of drug susceptibility were analyzed, retrospectively. Results There were 32 （6.68%） among the 479 patients were suffered from postoperative intra-abdominal infection, in which 27 （84.38%） patients had positive pathogen detection. Total of 32 bacilli lines were separated, of which 24 （75.00%） strains were Gram-negative bacilli, including 15 （46.86%） strains of Escherichia coli, 3 （9.38%） strains of Klebsiellap pneumonia and one strains of Proteus vulgaris, Proteus mirabilis, Enterobacter cloacae, Princeton marcescens, Acinetobacter and Pseudomonas aeruginosa, respectively （3.13%）. There were 7 （21.88%） strains of Gram-positive bacilli were separated, including 4 （12.50%） strains of Enterococcus faecali, one strains of Enterrococcus durali, Staphylococcus aureus and Staphylococcus hemolytic, respectively （3.13%）. Furthermore, one （3.13%） strains of Candida albicans was separated. Drug resistance rate of the separated pathogens to common-used antibiotics were relatively high. Drug susceptibility rate of Gram-negative bacteria to meropenem （91.67%） and Gram-positive bacteria to vancomycin （85.71%） was the highest, respectively. Conclusions The most common pathogens causing intra-abdominal infection after radical gastrectomy are Escherichia coli, Enterococcus faecali and Klebsiellap pneumonia, thus we should use antibiotics rationally.