腹腔术后肺部感染病原菌分布特点及耐药性分析

Analysis of distribution characteristics and drug resistance of pathogens causing pulmonary to patients treated with abdominal surgery

目的分析腹腔术后肺部感染病原菌分布特点及耐药性,为临床选择抗菌药物提供参考。方法选择2010年1月-2012年9月住院的腹腔手术患者671例,对术后发生肺部感染的53例患者痰标本进行病原菌检测,采用美国Dabe BehringMicroscan Workway40全自动细菌鉴定与药敏测试仪及其配套药敏鉴定板,进行相应的药敏试验,并对耐药性进行分析。结果 671例腹腔手术患者中有53例患者发生肺部感染,感染率7.9%;共分离出病原菌62株,其中革兰阴性菌34株占54.9%,革兰阳性菌25株占40.3%,真菌3株占4.8%,分离的前3位病原菌依次为肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌,分别占32.4%、30.7%、11.3%;病原菌对常用抗菌药物耐药严重,肺炎克雷伯菌除多黏菌素B、米诺环素未见耐药外,对其他抗菌药物的耐药率均>30.0%,耐甲氧西林金黄色葡萄对万古霉素、利奈唑胺耐药率为0,但对其他常用抗菌药物耐药率均>33.3%。结论腹腔术后肺部感染的病原菌以革兰阴性菌为主,且病原菌呈多药耐药性,经验性选择抗菌药物时应针对上述特点,以期获得更好的疗效。

OBJECTIVE To analyze the distribution characteristics and drug resistance of pathogens causing pulmonary infections to patients treated with abdominal surgery so as to provide reference for choosing antibiotics in clinical practice .METHODS A total of 671 cases of patients treated with abdominal surgery in the hospital from Jan 2010 to Sep 2012 were selected as the subjects ;the Dabe Behring Microscan Workway 40 full automatic bacteria identification instrument and drug sensitivity test instrument with matched accessory were adopted for bacteria identification and drug sensitivity test ,and the drug resistance was analyzed .RESULTS A total of 53 of the 671 patients treated with abdominal surgery suffered pulmonary infections ,with the infection rate of 7 .9% ;totally ,62 strains of pathogens were isolated ,with 54 .9% （34 strains）gram-negative strains ,40 .3% （25 strains） gram-positive strains ,and 4 .8% （3 strains） fungi;the top 3 isolated pathogens were K lebsiella pneumonia , Staphylococcus aureus and Pseudomonas aeruginosa ,accounting for 32 .4% ,30 .7% and 11 .3% respectively ;pathogens had severe resistance to the common antibiotics ;except that K . pneumonia was not resistant to polymyxin B and minocyline ,it had the drug resistance rate 30 .0% higher than all the other antibiotics ;the drug resistance rates of methicillin-resistant S .aureus to vancomycin and linezolid were 0 ,but all above 33 .3% to the other antibiotics .CONCLUSIONS The major pathogens causing pulmonary infection to patients treated with abdominal surgery were gram-negative bacteria ,and the pathogens had multi-drug resistance characteristics .So it is required to choose antibiotics as per the above characteristics so as to get better curative effects .