腹部手术部位感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing abdominal surgical site infections

目的了解腹部手术切口感染的病原菌分布及其耐药性,为切口感染的预防和治疗用药提供科学依据。方法对2009年9月-2012年10月医院腹部手术患者切口分泌物培养获得的145株病原菌复苏后重新鉴定,药敏试验采用K-B法,ESBLs检测采用纸片协同试验,MRSA和MRCNS检测采用头孢西丁纸片法。结果共分离病原菌145株,其中革兰阴杆菌96株占66.2%,革兰阳性菌45株占31.0%,真菌4株占2.8%;药敏试验结果显示,大肠埃希菌和肺炎克雷伯菌对亚胺培南和美罗培南全部敏感,铜绿假单胞菌对其耐药率均为31.3%;产ESBLs大肠埃希菌17株,检出率34.7%,产ESBLs肺炎克雷伯菌7株,检出率38.9%;表皮葡萄球菌和金黄色葡萄球菌未发现对呋喃妥因的耐药株,耐药率最高的是青霉素,为100.0%;金黄色葡萄球菌有6株为MRSA,检出率66.7%,表皮葡萄球菌有12株为MRCNS,检出率57.1%。结论腹部手术切口感染的病原菌以肠道和皮肤正常菌群为主,耐药性普遍较强,临床应加强腹部手术的无菌操作,及时取样送检,并根据细菌培养和药敏试验结果合理选用抗菌药物,预防和降低切口感染率。

OBJECTIVE To understand the distribution and drug resistance of pathogens causing abdominal surgical incision infections so as to provide scientific basis for prevention of the incision infections as well as the use of anti-biotics.METHODS Totally 145 strains of pathogens that were isolated from the incision secretions of the patients who underwent the abdominal surgery in the hospital from Sep 2009 to Oct 2012 were reconfirmed after the recov-ery,the drug susceptibility testing was performed by using K-B method,the ESBLs were detected with the use of disk synergy test,and the MRSA and MRCNS were detected by means of cefoxitin disk method.RESULTS A total of 145 strains of pathogens have been isolated,including 96 （66.2%）strains of gram-negative bacilli,45 （31.0%）strains of gram-positive bacteria,and 4 （2.8%）strains of fungi.The results of the drug susceptibility testing indicated that all the Escherichia coli and Klebsiella pneumoniae strains were susceptible to imipenem and meropenem and that the drug resistance rates of the Pseudomonasaeruginosa to the two drugs were 31.3%.Total-ly 17 strains of ESBLs-producing E.coli were detected,with the detection rate of 34.7%,and 7 strains of ESBLs-producing K.pneumoniae were detected,with the detection rate of 38.9%.No strain of Staphylococcusepidermi-dis or Staphylococcus aureus resistant to nitrofurantoin was found,and the drug resistance rate to penicillin was the highest （100.0%）.Among the isolated S.aureus strains,6 strains of MRSA were detected,with the detection rate of 6 6 .7%,and 1 2 strains of MRCNS were detected among the isolated S.epidermidis strains,with the detec-tion rate of 57.1%.CONCLUSION The normal intestinal and skin flora are dominant among the pathogens causing the abdominal surgical incision infections and are highly drug-resistant.It is necessary for the hospital to strengthen the aseptic operation of the abdominal surgery,sample and submit the specimens in a timely manner,and reasona-bly use antibiotics on the basis of the results of the bacterial culture as well as the drug susceptibility testing so as to reduce the incidence of the incision infections.