综合医院普外科医院感染病原菌与耐药分析

Analysis of drug resistance and distribution of pathogenic bacteria acquired from department of pathogenic from general surgery infection

目的探讨综合医院普通外科医院感染病原菌分布特点及耐药性，为预防和控制医院感染，指导临床合理使用抗菌药物提供依据。方法对2011年1月至2013年12月普外科病房74例医院感染病例送检标本中培养分离出的149株病原菌的分布及耐药性，利用SPSSl7．0软件进行分析，计数资料采用率、构成比描述，率的比较采用，检验。P〈0．01为差异有统计学意义。结果普外科感染部位依次为下呼吸道（33．33％）、血液（15。15％）和腹腔（13．13％）。149株病原菌，其中革兰阴性杆菌109株（73．15％），革兰阳性球菌20株（13．42％），真菌20株（13．42％）；感染的革兰阴性杆菌中，位居前3位依次为鲍曼不动杆菌（26．85％），大肠埃希菌（17．45％），铜绿假单胞菌（14．09％）。革兰阳性球菌中，依次为D群屎肠球菌（5．37％）、人葡萄球菌（3．36％）和表皮葡萄球菌（1．34％）。分析了2304例普外科手术病例，术后肺部感染率1．82％，手术部位感染率2．39％；与全院患者肺部感染率3．12％，手术部位感染率7．90％相比，差异均有统计学意义（r=11．95，，=93．33，P〈0．01）。对抗菌药物产生耐药：鲍曼不动杆菌51．52％，大肠埃希菌42．42％，铜绿假单咆菌24．24％（耐药率在71．3％～100％）。结论普通外科临床病原菌耐药呈上升趋势，多药耐药日趋严重，加强普外科病原菌耐药性检测，根据药敏试验结果用药，对防止耐药菌株产生和扩散，降低和治疗外科感染是十分必要和有效的措施。

Objective To investigate the distribution and drug resistance of hospital-acquired pathogenic bacteria of department of general surgery, and to guide the prevention and control hospital infection. Methods 149 strains of pathogenic bacteria from 74 patients were isolated ard identified in department of general surgery from Jan 2011 to Dec 2013, and ~he drug resistance was also analyzed. Statistical analysis, including rate and ratio, was performed by chi-square test, using SPSS17.0 software. A P value 〈 0.01 was considered statistically significant. Results The infection sites of hospital-acquired infection included lower respiratory tract （33.33%）, blood （15.15%） and abdominal cavity （13.13%）. Among 149 isolated strains of pathogenic bacteria, there were 109 strains of Gram-negative bacillus （73.15%） , 20 strains of Gram-positive bacillus （ 13. 42% ） and 20 strains of fungus （ 13. 42% ）. Gram-negative bacillus consisted of Acinetobacter baumannii （ 26.85% ） , Escherichia coli （ 17.45% ）, Pseudomonas aeruginosa （14. 09% ）. Gram-positive bacillus consisted of D excrement enterococcus （5.37 % ）, staphylococcus hominis （3.36%） and staphylococcus epidermids （ 1.34% ）. Statistical analysis of 2 304 cases, who receive surgical treatment in department of general surgery, showed 1. 82% of pulmonary infection and 2.39% of infection of surgical sites, which were significantly lower than 3.12% of pulmonary infection and 7.90% of infection of surgical sites in whole hospital （X2=11.95, X2 = 93.33, P 〈 0.01 ）. Acinetobacter baumannii resisted to 51.52% of antibacterial drugs, escherichia coli resisted to 42.42% ofantibaeterialdmgs, pseudomonas aeruginosa resisted to 24.24% of antibacterial drags （The drug resistance rate ranged 71.3% - 100% ）. Conculsions Bacterial resistance of antibacterial drugs is increasing recently, and multi-resistance is getting more serious. The isolation and drug resistance detection of hospital-acquired pathogenic bacteria in department of general surgery should be strengthened. Rational use of antibiotic and the prevention of drug resistance strains could be achieved by drug sensitive test, which is vital for the prevention and management of surgical infection.