妇科肿瘤术后盆腔感染患者的病原学分析与抗菌药物应用

Etiological analysis for patients with pelvic infection after gynecologic tumor surgery and use of antibiotics

目的了解妇科肿瘤患者术后盆腔感染的常见病原菌种类及药敏性,探讨抗菌药物临床合理应用。方法选择医院2012年3月-2013年3月36例妇科肿瘤术后盆腔感染患者,严格无菌取盆腔分泌物进行病原菌培养,依据《全国临床检验操作规程》进行常规分离培养和鉴定,药敏试验采用K-B纸片法,根据美国临床实验室标准化研究所(CLSI)相关文件判定细菌耐药性。结果 36例妇科肿瘤术后盆腔感染患者取盆腔分泌物培养,共培养出病原菌46株,其中革兰阳性菌12株,占26.08%,以表皮葡萄球菌、金黄色葡萄球菌和溶血葡萄球菌为主,分别占10.87%、6.52%、4.35%;革兰阴性菌31株,占67.40%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主,分别占26.09%、15.22%、13.04%;真菌3株占6.52%;革兰阴性菌对临床常用的氨苄西林耐药率达100.00%,对头孢类抗菌药物、左氧氟沙星、环丙沙星耐药率均>50.00%,对头孢哌酮/舒巴坦、阿莫西林/克拉维酸、庆大霉素、阿米卡星耐药率较低,革兰阳性菌对氨苄西林、环丙沙星、庆大霉素的耐药率分别为91.67%、83.33%、58.33%,对万古霉素的耐药率为0;36例患者经抗感染治疗与引流后痊愈,无其他相关并发症。结论革兰阴性菌仍是盆腔感染的主要病原菌,所占比例较大,其对常见抗菌药物的耐药性普遍较高,提示合理用药,降低耐药菌株的产生。

OBJECTIVE To understand the species and drug sensitivity of common pathogenic bacteria causing pelvic infections to patients after gynecologic tumor surgeries and to discuss the rational use of antibiotics in clinical practice .METHODS A total of 36 cases of pelvic infection patients after the gynecologic tumor surgeries from Mar 2012 to Mar 2013 were selected for pathogen culture with pelvic secretion strictly taken by sterile procedures ;normal isolation culture and identification were performed according to National Clinical Laboratory Procedures and Kirby-Bauer method was adopted for drug sensitivity test ;the bacterial resistance was determined according to the reference documents issued by the Clinical and Laboratory Standards Institute （CLSI） .RESULTS A total of 46 strains of pathogens were obtained through culturing pelvic secretions taken from the 36 cases of pelvic injection patients after the gynecologic tumor surgeries ,including 12 （26 .08% ） strains of gram-positive bacteria ,31 （67 .40% ） strains of gram-negative bacteria ,and 3 （6 .52% ） strains of fungi ;the Staphylococcus epidermidis , S .aureus and S .haemolyticus were dominant among the gram-positive bacteria ,accounting for 10 .87% ,6 .52% , and 4 .35% respectively ;the Escherichia coli ,K lebsiella pneumoniae and Pseudomonas aeruginosa were dominant among the gram-negative bacteria ,accounting for 26 .09% ,15 .22% ,and 13 .04% respectively .The drug resistance rate of the gram-negative bacteria to ampicillin commonly used in clinical practice was up to 100 .00% ;the drug resistance rates to cephalosporin antibiotics ,levofloxacin and ciprofloxacin were all above 50 .00% ,while the drug resistance rates to cefoperazone-sulbactam ,amoxicillin-clavulanate potassium ,gentamicin and amikacin were low ;the drug resistance rates of the gram-positive bacteria to ampicillin ,ciprofloxacin and gentamicin were 91 .67% ,83 .33% ,and 58 .33% respectively ,while the drug resistance rate to vancomycin was 0 .All the 36 patients were recovered by anti-infection treatment and drainage treatment without other related complications . CONCLUSIONS Gram-negative bacteria are still the main pathogens causing pelvic infections ,accounting for a large proportion and have generally high drug resistance to common antibiotics ;indication of rational use of drug can reduce the production rate of drug resistant bacteria .