围手术期患者呼吸道感染的临床特点及预防研究

Clinical characteristics of respiratory tract infections in patients during perioperative period and prevention countermeasures

目的研究围手术期患者呼吸道感染的临床特点及相关预防措施。方法收集医院2012年1月-2015年1月围手术期医院呼吸道感染患者送检标本520份,分析患者感染病原菌种类分布及其耐药性特点,提出相关有效预防对策。结果围手术期患者呼吸道标本共检出病原菌650株,其中主要来自神经外科和普通外科分别占48.2%和34.3%;650株病原菌主要为革兰阴性菌298株,占45.85%,革兰阳性菌115株占17.69%,真菌237株占36.46%,共检测出多药耐药菌68株,占10.46%,主要以产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和产ESBLs肺炎克雷伯菌为主;大肠埃希菌、鲍氏不动杆菌以及肺炎克雷伯杆菌对氨苄青霉素的耐药性≥95%,金黄色葡萄球菌和表皮葡萄球菌对氨苄青霉素、青霉素以及克林霉素的耐药性≥75%;白假丝酵母菌对氟胞嘧啶的耐药率为92.1%,白假丝酵母菌和光滑假丝酵母菌对其它抗真菌药物的耐药率≤10.1%。结论加强围手术期相关抗菌药物的预防性用药,提高围手术期患者呼吸道标本送检率并做好经常性药敏试验,对降低围手术期患者呼吸道感染率及提高治疗效果有着重要意义,值得临床推广。

OBJECTIVE To investigate the clinical characteristics of respiratory tract infections in patients during perioperative period and put forward the related prevention measures.METHODS Totally 520 submitted specimens were collected from the patients who had the respiratory tract infection during perioperative period from Jan 2012 to Jan 2015.The distribution and drug resistance of the pathogens causing the infections were observed,and the effective prevention countermeasures were put forward.RESULTS A total of 650 strains of pathogens were isolated from respiratory tract specimens during the perioperative period,of which 48.2% were isolated from neurosurgery department,and 34.3% were isolated from general surgery department.Among the 650 strains of pathogens,there were 298（45.85%）strains of gram-negative bacteria,115（17.69%）strains of gram-positive bacteria,and237（36.46%）strains of fungi.Totally 68 strains of multidrug-resistant organisms were isolated,accounting for10.46%,and extended-spectrum beta-lactamases（ESBLs）-producing Escherichia coli and ESBLs-producing Klebsiella pneumoniae were dominant.The drug resistance rates of the E.coli,Acinetobacter baumannii,and K.pneumoniae to ampicillin were more than 95%;the drug resistance rates of Staphylococcus aureus and Staphylococcus epidermidis to ampicillin,penicillin,and clindamycin were more than 75%;the drug resistance rate of Candida albicans to flucytosine was 92.1%,and the drug resistance rates of C.albicans and Candida glabratato other antifungal agents were no more than 10.1%.CONCLUSIONIt is of great significance to strengthen the prophylactic use of related antibiotics during the perioperative period,raise the submission rate of respiratory tract specimens,and conduct the drug susceptibility testing so as to reduce the incidence of respiratory tract infections during the perioperative period and improve the therapeutic effect,which is worthy to be promoted in the hospital.