牧区与城镇患者胃肠手术切口感染病原菌分布与药敏分析

Distribution and Drug Susceptibility of Pathogens in Patients Causing Incision Infections Undergoing Gastrointestinal Surgery in Pastoral Areas and Urban

目的分析牧区与城镇胃肠手术患者切口感染分泌物中病原菌的分布及药敏性,为临床合理用药提供参考。方法选取2010年5月至2015年5月收治的牧区与城镇胃肠手术并发切口感染的患者,分别为90例,96例。对患者采取切口分泌物样本进行病原菌的分布以及药敏分析,药敏结果采用CLSI2010标准判断,采用WHONET5.6软件统计分析结果。结果牧区与城镇90例和96例患者分泌物标本培养出病原菌100株和109株,其中革兰阴性菌分别为69株和80株占69.0%、83.3%,革兰阳性菌26株与36株,分别占26.0%、35%,真菌5株与6株,占5.0%、5.8%;革兰阴性菌对哌拉西林/他唑巴坦等的耐药率最低,其次为妥布霉素、亚胺培南、克林霉素等,耐药率均<30.0%;革兰阳性菌对万古霉素的耐药率为0,其次为氨苄西林、高浓度庆大霉素、高浓度链霉素、环丙沙星等。结论牧区与城镇患者胃肠手术患者切口感染分泌物中病原菌的分布以铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、肠球菌属及肺炎克雷伯菌、粪肠球菌等为其主要病原菌,显示有耐药性差别,但在临床长期用药中,应根据患者分泌物药敏试验结果对抗菌药物进行合理选择,避免多重耐药菌株的产生。

Objective To investigate the distribution and drug susceptibility of the pathogens isolated from the secretions specimens of the gastrointestinal surgery in pastoral areas and urban patients complicated with incision infections so as to provide guidance for reasonable clinical use of antibiotics. Methods A total of 90 Pastoral areas and 96 urban patients complicated with incision infections that were treated from May 2010 to May 2015 were enrolled in the study. All the participants received the operations,then the secretions specimens were sampled to observe the distribution and drug susceptibility of the pathogens,and the statistical analysis was performed with the use of CLSI 2010 and WHONET5. 6. Results Of 90 and 96 secretions specimens,69 and 80 were cultured positive,with the detection rate of 76. 7% and 83. 3%. Totally 100 and 109 strains of pathogens have been isolated,including 69（ 69. 0%） and 61（ 59. 2%） strains of gram-negative bacteria,26（ 26. 0%）and 36（ 35. 0%） strains of gram-positive bacteria,and 5（ 5. 0%） and 6（ 5. 8%） strains of fungi. The drug resistance rate of the gram-negative bacteria to piperacillin sodium / tazobactam sodium was the lowest,and the drug resistance rates to tobramycin,imipenem,and clindamycin were less than 30. 0%. The drug resistance rate of the gram-positive bacteria to vancomycin was 0,and followed by ampicillin,gentamicin,streptomycin and ciprofloxacin. Conclusion There is difference in the distribution of the pathogens isolated from the secretions specimens in pastoral areas and urban patients. It is necessary for the hospital to reasonably use antibiotics based on the results of drug susceptibility testing for the pathogens isolated from the secretions specimens.