腹股沟疝无张力修补术后医院感染的病原菌分布特征与耐药性分析

Distribution and drug resistance of pathogens causing postoperative nosocomial infections in patients undergoing tension-free inguinal hernia repair

目的调查医院腹股沟疝无张力修补术后患者医院感染病原菌种类,分析病原菌的分布及耐药性,为临床该类手术感染的早期预防和术后治疗方案提供策略。方法收集2014年6月~2016年6月在医院行腹股沟疝无张力修补术患者800例,对术后感染患者采集感染部位分泌物进行细菌培养和耐药性分析。结果 800例腹股沟疝无张力修补术患者共发生术后医院感染35例,感染率为4.38%,感染部位有切口感染、泌尿系统感染以及呼吸系统感染。35例医院感染患者脓液培养获得病原菌69株,革兰阳性菌43株,占62.32%,革兰阴性菌25株,占36.23%。金黄色葡萄球菌、肺炎链球菌、表皮葡萄球菌对青霉素和磺胺甲恶唑/甲氧苄啶耐药性高,铜绿假单胞菌对头孢他啶、亚胺培南和阿米卡星均有较高的敏感性,耐药率均较低;鲍曼不动杆菌对临床常用的抗菌药物均表现出高度的耐药性;肺炎克雷伯菌及大肠埃希菌对头孢他啶、亚胺培南、磺胺甲恶唑/甲氧苄啶以及氨苄西林均敏感,耐药率均较低。结论医院腹股沟疝无张力修补术后患者医院感染病原菌感染以革兰阳性菌等为主,病原菌对不同抗菌药物表现出不同耐药性,耐药情况有普遍加强的趋势,该类临床手术应在治疗前予以联合抗菌用药,术后有针对性的及时调整,预防术后医院感染的发生。

OBJECTIVE To investigate the species of pathogens causing postoperative nosocomial infections in patients undergoing tension-free inguinal hernia repair and analyze the distribution and drug resistance of the patho- gens so as to provide guidance for early prevention and treatment of the postoperative infection. METHODS A total of 800 patients who underwent the tension-free inguinal hernia repair in the hospital from Jun 2014 to Jun 2016 were enrolled in the study. The secretions specimens were collected from the infection sites of the patients with the postoperative infection for bacterial culture, and the drug resistance was observed. RESULTS Of the 800 patients who underwent the tension-free inguinal hernia repair, 35 had the postoperative nosocomial infection, with the in- fection rate 4. 38%. The infection sites included incision, urinary system, and respiratory system. Totally 69 strains of pathogens were isolated from the pus specimens of the 35 patients with nosocomial infection, including 43 （62.32%） strains of gram-positive bacteria and 25 （36.23%） strains of gram-negative bacteria. The drug resistance rates of Staphylococcus aureus, Streptococcus pneumoniae, and Staphylococcus epidermidis strains to penicillin and sulfamethoxazole-trimethoprim were the highest~ Pseudomonas aeruginosa strains were highly sus commonly used antibiotics; the drug resistance rates of Klebsiella pneumoniae and Escherichia coli strains to ceftazidime, imipenem, sulfamethoxazole-trimethoprim, and ampicillin were low. CONCLUSION The gram-positive bacteria are dominant among the pathogens causing the postoperative nosocomial infections in the patients undergo- ing the tension-free inguinal hernia repair. The pathogens vary in the resistance to the antibiotics, and the drug re sistance rate is increased, therefore, it is necessary to carry out the combined drug therapy before the clinicalsurgery and conduct targeted adjustment in a timely manner after the surgery so as to prevent the postoperative nosocomial infections.