胃癌患者术后医院感染病原菌与影响因素分析

Distribution of pathogens causing postoperative nosocomial infections in gastric cancer patients and influencing factors

目的分析胃癌患者术后发生医院感染病原菌分布及其相关影响因素,并针对性提出预防对策,以降低感染率。方法回顾性分析2003年8月-2015年8月行手术的468例胃癌患者临床资料,采集患者各类标本进行细菌分离鉴定,并分析影响医院感染的相关因素,采用SPSS20.0软件进行统计分析。结果 468例胃癌患者术后发生医院感染61例,感染率13.03%,共检出68株病原菌,革兰阴性菌42株占61.76%,革兰阳性菌18株占26.47%,真菌8株占11.76%;大肠埃希菌、铜绿假单胞菌及肺炎克雷伯菌对阿米卡星﹑环氧沙星、头孢吡肟耐药率均≥50.00%,而对他唑巴坦、哌拉西林、头孢替坦耐药率均≤33.33%,对亚胺培南最敏感,耐药率均为0;肠球菌属、金黄色葡萄球菌及表皮葡萄球菌对亚胺培南、利奈唑胺、替考拉宁耐药率均为0,对阿莫西林/克拉维酸及氨苄西林存在不同程度的耐药性;胃癌患者术后发生医院感染与手术持续时间、术前抗菌药物应用、术前住院时间、病理类型、血白细胞水平、手术范围及营养状态有关(P<0.05)。结论胃癌患者术后发生医院感染病原菌分布广泛,可通过降低手术住院时间,合理使用抗菌药物及营养支持,降低医院感染的发生。

OBJECTIVE To investigate the distribution of pathogens causing nosocomial infections in the gastric cancer patients,explore the related influencing factors,and put forward the targeted prevention countermeasures so as to reduce the infection rate.METHODS The clinical data of 468 gastric cancer patients who underwent surgeries from Aug 2003 to Aug 2015 were retrospectively analyzed,then the various specimens were collected for the bacterial isolation and identification,the related influencing factors for the nosocomial infections were observed,and the statistical analysis was performed with the use of SPSS20.0software.RESULTS Of the 468 gastric cancer patients,61 had postoperative nosocomial infections with the infection rate of 13.03%.A total of 68 strains of pathogens were isolated,including 42（61.86%）strains of gram-negative bacteria,18（26.74%）strains of grampositive bacteria,and 8（11.76%）strains of fungi.The drug resistance rates of the Escherichia coli,Pseudomonas aeruginosa,and Klebsiella pneumoniae to amikacin,epoxy gatifloxacin and cefepime were no less than50.00%,while the drug resistance rates to tazobactam,piperacillin,and cefotetan were no more than 33.33%,and the drug resistance rate to imipenem was 0.The drug resistance rates of the Enterococcus spp,Staphylococcus aureus,and Staphylococcus epidermidis to imipenem,linezolid,and teicoplanin were 0,and the strains varied in the drug resistance to amoxicillin-clavulanic acid and ampicillin.The incidence of the postoperative nosocomial infections in the gastric cancer patients was associated with the operation duration,preoperative use of antibiotics,preoperative length of hospital stay,pathological pattern,white blood cell level,scope of surgery,and nutritional status（P〈0.05）.CONCLUSION The pathogens causing the postoperative nosocomial infections in the gastric cancer patients are widely distributed.It is necessary to shorten the length of hospital stay,reasonably use antibiotics,and conduct the nutrition support so as to reduce the incidence of the nosocomial infections.