肺叶切除患者术后医院感染的病原学分析及临床治疗

Etiological analysis of nosocomial infections after lobectomy and clinical treatment

目的探讨肺叶切除患者术后医院感染的病原学特点,并提出相应的临床治疗方法。方法选取老年肺癌行肺叶切除治疗的患者1 372例,对发生医院感染患者的临床资料进行回顾性分析,取感染部位标本进行病原学和耐药性检验。结果 1 372例手术患者发生医院感染126例,感染率为9.18%;共分离出病原菌521株,其中以革兰阴性菌最多占64.11%,其次革兰阳性菌占31.09%,真菌检出率最低仅占4.80%;革兰阴性菌对三代头孢类抗菌药物耐药性普遍较高,除嗜麦芽寡养单胞菌外,对其他病原菌均对亚胺培南较为敏感,除肠球菌属外所有革兰阳性菌均对青霉素100.00%耐药,未发现对万古霉素耐药菌株。结论老年肺叶切除患者术后医院感染病原菌多样,且很多为多重感染,应及时进行药敏分析,并在结果出来前早期给予经验性用药,为减少医院感染的发生,应对高危患者给予更多关注,积极治疗合并症后再进行手术。

OBJECTIVE To investigate the etiological characteristics of the postoperative nosocomial infections in patients undergoing lobectomy so as to propose corresponding clinical treatment measures. METHODS A total of 1372 elderly patients with lung cancer who underwent the lobectomy were enrolled in the study, then the clinical data of the subjects with postoperative nosocomial infections were retrospectively analyzed, the specimens were sampled from the infection sites for the etiological analysis and the drug resistance test. RESULTS Of totally 1372 patients, the nosocomial infections occurred in 126 cases with the infection rate of 9.18%. A total of 521 strains of pathogens have been isolated, among which the gram negative bacteria accounted for 64.11%, the gram positive bacteria 31.09 %, the fungi 4.80 %. The gram-negative bacteria were highly resistant to the third generation ceph- alosporins and were susceptible to imipenem except for Stenotrophomonas maltophilia ; all the gram-positive bacteria were 100.00% resistant to penicillin except for Enterococci, and the strains resistant to vancomycin have not been detected. CONCLUSION There are a variety of pathogens causing postoperative nosocomial infections in the elderly patients undergoing lobectomy, and some cases are with multiple infections. The drug susceptibility testing should be performed in a timely manner, empirical medication should be carried out in early stage so as to reduce the incidence of nosoeomial infections; it is necessary to pay more attention to the critically ill patients to actively treat the complications before the surgery.