住院手术患者切口感染病原菌分布与耐药性研究

Distribution and drug resistance of pathogenic bacteria causing surgical incision infection in inpatients

目的分析住院手术患者切口感染病原菌分布特点及其对常用抗菌药物的耐药性,为临床合理用药提供依据。方法选择2013年1月-2015年1月29 000例住院手术患者,留取发生感染患者切口分泌物进行细菌培养及药物敏感性测定,采用全自动细菌鉴定仪对病原菌进行菌种鉴定,药敏试验采用K-B法,操作和结果判断按NCCLS 1999年推荐的标准进行。结果 29 000例住院手术患者中发生切口感染989例,感染率3.4%;共分离出病原菌887株,革兰阳性菌252株占28.4%,革兰阴性菌618株占69.7%;检出率排前5位的病原菌分别为大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌;金黄色葡萄球菌对万古霉素的耐药率为0;大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率为0;铜绿假单胞菌对阿米卡星的耐药率最低为6.4%;鲍氏不动杆菌对头孢哌酮/舒巴坦耐药率最低为8.9%。结论住院手术患者切口感染的主要病原菌是大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌和铜绿假单胞菌,临床经验性用药应根据病原菌监测和药敏试验结果科学选择抗菌药物。

OBJECTIVE To analyze the distribution of pathogens causing surgical infections in inpatients and the resistance to commonly used antibiotics so as to provide the basis for rational drug use.METHODS The cases of incision infections among the 29 000 inpatient undergoing surgeries from Jan.2013 to Jan.2015 were selected.Incision secretion specimens were collected and cultured for drug sensitivity test.The fully automatic bacteria identifier was used for pathogen identification and the K-B method was used for susceptibility test.The operation and the result interpretation were conducted according to the standards recommended by NCCLS in the year 1999.RESULTS Totally 989 cases of incision infection occurred among the 29 000 inpatients,the infection rate was3.4%.Totally 887 pathogenic strains were isolated,including 252 strains of gram-positive bacteria accounting for28.4%,618 strains of gram-negative bacteria accounting for 69.7%.Pathogens with detection rates ranking the top five were E.coli,Staphylococcus aureus,Klebsiella pneumoniae,Pseudomonas aeruginosa,and Acinetobacter baumannii.Resistance of S.aureus to vancomycin was 0,the same as E.coli and K.pneumoniato imipenem.P.aeruginosa had the lowest resistance of 6.4% to amikacin.A.baumannii had the lowest resistance of8.9%to cefoperazone/sulbactam.CONCLUSION The main pathogenic bacteria for surgical incision infection are E.coli,S.aureus,K.pneumoniae,and P.aeruginosa.The clinical empirical administration should be based on the pathogenic bacterial monitoring and the susceptibility results so as to achieve scientific selection of antibiotics.