胆囊切除患者术后医院感染病原菌与耐药性分析

Distribution and drug resistance of pathogens causing postoperative nosocomial infections in patients undergoing cholecystectomy

目的探讨胆囊切除患者术后医院感染病原菌分布及耐药性,为降低胆囊切除术后患者医院感染的发生提供参考依据。方法选取2012年1月-2014年8月肝胆外科156例行胆囊切除术患者为研究对象,术后发生感染42例,分析感染病原菌分布及其耐药率,并探讨预防感染的有效方法。结果 156例行胆囊切除术患者术后发生医院感染42例,感染率为26.92%,开腹胆囊切除术患者感染率显著高于腹腔镜胆囊切除术患者(P<0.05);共分离出72株病原菌,其中革兰阳性菌25株占34.72%,革兰阴性菌45株占62.50%,真菌2株占2.78%;革兰阴性菌对亚胺培南、美罗培南、阿卡米星、妥布霉素的耐药率较低,革兰阳性菌对利奈唑胺、替考拉宁、氧氟沙星的耐药率较低。结论为有效预防及控制胆囊切除术后患者医院感染的发生,应在手术前后做好干预,术中严格无菌操作,并根据药敏试验结果合理选用抗菌药物。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing postoperative nosocomial infections in the patients undergoing cholecystectomy so as to provide guidance for reduction of incidence of the postoperative nosocomial infections.METHODS A total of 156 patients who underwent the cholecystectomy in the department of hepatobiliary surgery from Jan 2012 to Aug 2014 were enrolled in the study,of whom 42 had the postoperative nosocomial infections.The distribution and drug resistance of the pathogens were observed,and the effective prevention measures of the infections were explored.RESULTS Of 156 patients undergoing the cholecystectomy,42 had the postoperative nosocomial infections,with the infection rate of 26.92%.The incidence of the postoperative nosocomial infections was significantly higher in the patients undergoing the open cholecystectomy than in the patients undergoing the laparoscopic cholecystectomy（P〈0.05）.Totally 72 strains of pathogens were isolated,including 25（34.72%）strains of gram-positive bacteria,45（62.50%）strains of gram-negative bacteria,and 2（2.78%）strains of fungi.The drug resistance rates of the gram-negative bacteria to imipenem,meropenem,amikacin,and tobramycin were relatively low;the drug resistance rates of the gram-positive bacteria to linezolid,teicoplanin,and ofloxacin were relatively low.CONCLUSIONIt is necessary to take interventions before the surgery,carry out strict aseptic operations during the surgery,and reasonably use antibiotics based on the results of the drug susceptibility testing so as to effectively prevent and control the postoperative nosocomial infections in the patients undergoing the cholecystectomy.