肝胆外科手术后感染的病原菌分布与耐药性分析

The distribution of pathogenic bacteria and analysis of drug resistance on surgical site infections in patients with hepatobiliary surgeries

目的探讨肝胆外科患者术后手术部位感染的病原菌种类、分布及耐药性,以期预防和治疗术后感染,并指导临床合理使用抗菌药物。方法对肝胆外科手术后发生感染85例患者的临床资料进行回顾性分析,分离培养送检标本,并对检出的主要病原菌进行药物敏感试验。结果 85例患者共检出115株病原菌,标本来源为胆汁30.43%、痰液26.96%、脓液24.35%。其中,革兰阳性菌40株,占34.78%,其中金黄色葡萄球菌占15.65%、表皮葡萄球菌占10.43%、溶血葡萄球菌占6.09%和粪肠球菌占2.61%,对青霉素G、氨苄西林、环丙沙星、庆大霉素、甲氧苄啶、红霉素、四环素等药物有较高的耐药性,而对替考拉宁和利奈唑胺有较低耐药性,对万古霉素极度敏感。检出革兰阴性菌75株,占65.22%,其中肺炎克雷伯菌占19.13%、大肠埃希菌占17.39%、铜绿假单胞菌占14.78%、阴沟肠杆菌占8.70%,对妥布霉素、亚胺培南、美罗培南及阿米卡星均有较高的敏感性,对沙星类、头孢类、庆大霉素及红霉素具有较高的耐药性。结论在肝胆外科手术中,临床医师应严格执行无菌操作,当发生术后感染时应合理选择耐药性较低的抗菌药物。

Objective To investigate and analyze the types, distribution and drug resistance of pathogenic bacteria on surgical site infections in patients with hepatobiliary surgeries, so as to prevent and treat postoperative infection, and to guide clinical rational use of antibiotics. Methods The clinical data of 85 patients with infection after operation in Department of Hepatobiliary Surgery were retrospectively analyzed. The detected samples were isolated and cultured,then the main pathogenic bacteria were performed by drug sensitive test. Results 115 strains of pathogenic bacteria were detected in 85 patients,speci- men source of pathogenic bacteria was respectively in bile （ accounted for 30.43% ） ,mucus （ accounted for 26.96% ） and pus （accounted for 24.35 % ）. Gram positive bacteria were 40 strains, accounting for 34.78 %, staphylococcus aureus （ 15.65 % ）, staphylococcus epidermidis （ 10.43 % ）, staphylococcus haemolyticus （ 6.09% ） and enterococcus faecalis （2.61% ）. They had high drug resistance to penicillin G, ampicillin, ciprofloxacin, gentamicin, trimethoprim, erythromycin and tetracycline, with less resistance to teicoplanin and linezolid. It had extremely sensitive to vancomycin. Gram negative bacteria were 75 strains, ac- counting for 65.22%, klebsiella pneumoniae （ 19.13 % ）, escherichia coli （ 17.39% ）, pseudomonas aeruginosa （ 14.78% ）, en- terubacter cloacae（ 8.70% ）, they had high sensitivity to tobramycin, imipenem, meropenem and amikacin, and with high drug resistance to ciprofloxacin,cephalosporin, gentamicin and erythromycin. Conclusion In the department of hepatobiliary sur- gery, clinicians should strictly carry out aseptic operation, rationally selected the antimicrobial agents with low drug resistance when infection occurs.