普外科高龄患者上腹部术后肺部感染状况研究

Prevalence of postoperative pulmonary infections in elderly patients undergoing upper abdominal surgery in department of general surgery

目的探讨普外科高龄患者上腹部手术后肺部感染的病原菌分布及耐药性,为临床合理使用抗菌药物提供依据。方法选取医院普外科2013年1月-2015年5月收治的450例上腹部手术患者作为研究对象,对发生肺部感染的患者进行病原菌检测及药敏试验,对病原菌分布及耐药性进行分析,采用Excel软件进行数据统计分析。结果 450例高龄上腹部手术患者中发生肺部感染39例,感染率为8.67%;感染患者送检标本中共检出53株病原菌,其中革兰阴性菌46株占86.79%,革兰阳性菌6株占11.32%,真菌1株占1.89%;高龄患者上腹部手术术后肺部感染病原菌对常用抗菌药物几乎均存在不同程度耐药性,革兰阴性菌中铜绿假单胞菌对第三代头孢、阿莫西林、庆大霉素具有很高耐药率,均>50.00%。结论普外科高龄患者上腹部手术后肺部感染病原菌以革兰阴性菌为主,病原菌呈现多药耐药性,根据药敏试验结果选择抗菌药物可起到满意疗效。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing postoperative pulmonary infections in elderly patients undergoing upper abdominal surgery in department of general surgery so as to provide guidance for reasonable clinical use of antibiotics.METHODS A total of 450 patients who underwent the upper abdominal surgery in the department of general surgery from Jan 2013 to May 2015 were recruited as the study objects,the pathogens were detected for the patients with pulmonary infections,the drug susceptibility testing was carried out,the distribution and drug resistance of the pathogens were observed,and the statistical analysis of data was performed with the use of Excel software.RESULTS Of the 450 elderly patients undergoing the upper abdominal surgery,39 had pulmonary infections,with the infection rate 8.76%.Totally 53 strains of pathogens were isolated from the submitted specimens,including 46（86.79%）strains of gram-negative bacteria,6（11.32%）strains of gram-positive bacteria,and 1（1.89%）strain of fungus.The pathogens causing the postoperative infections in the elderly patients undergoing upper abdominal surgery varied in the drug resistance to the commonly used antibiotics.Among the gram-negative bacteria,the Pseudomonas aeruginosa was highly resistant to the third generation cephalosporins,amoxicillin,and gentamicin,with the drug resistance rate more than50.00%.CONCLUSIONThe gram-negative bacteria are dominant among the pathogens causing the postoperative pulmonary infections in the elderly patients undergoing the upper abdominal surgery in the department of general surgery,and the pathogens show multidrug-resistant.The antibiotics should be used on the basis of the results of the drug susceptibility testing,which may achieve satisfactory effect.