原发性肝癌患者术后医院感染病原学特点及危险因素分析

Pathogenic characteristics and risk factors of postoperative nosocomial infections in patients with primary hepatic carcinoma

目的分析原发性肝癌患者术后医院感染的病原菌特点及危险因素。方法选择2015年1月-2016年12月于医院行手术治疗的150例原发性肝癌患者的临床资料,分析术后发生感染的相关因素及感染病原菌的分布和药敏结果。结果原发性肝癌术后感染33例,感染率22.00%,共培养分离88株病原菌,其中革兰阴性菌53株占60.23%,以大肠埃希菌为主;革兰阳性菌33株占37.50%,以肠球菌为主;真菌2株占2.27%;革兰阴性菌对头孢唑林、头孢曲松、氨苄西林等抗菌药物耐药性较高,部分可达100%,而对头孢唑肟、亚胺培南、哌拉西林舒巴坦及头孢哌酮/舒巴坦等较敏感;革兰阳性菌对氨苄西林、克林霉素等普遍耐药,但对万古霉素,替考拉宁,利福平等仍然较敏感;年龄、肝功能不全、手术时间、失血量、输血因素、术中损伤左右肝管及术后行T管引流是原发性肝癌患者发生感染的独立危险因素(P<0.05)。结论原发性肝癌患者术后发生感染病原菌以革兰阴性致病菌为主,应选用头孢唑肟、亚胺培南、哌拉西林舒巴坦及头孢哌酮/舒巴坦等敏感药物,并依据引起感染的危险因素进行适当防范。

OBJECTIVE To analyze the pathogenic characteristics and related factors of postoperative nosocomial infections in patients with primary hepatic carcinoma.METHODS A total of 150 patients with primary hepatic carcinoma from Jan.2015 to Dec.2016 in our hospital were selected,and the related factors of postoperative infections,distribution of pathogens and drug sensitivity test results were analyzed.RESULTS There were 33 cases of postoperative infections of primary hepatic carcinoma,and the infection rate was 22.00%.Totally 88 strains of pathogens were isolated,including 53 strains of gram-negative bacteria accounting for 60.23%,mainly Escherichia coli,33 strains of gram-positive bacteria accounting for 37.50%,mainly Enterococcus,and 2 strains of fungi accounting for 2.27%.Gram-negative bacteria had high resistant rates to cefazolin,ceftriaxone and ampicillin,some up to 100%,and were sensitive to ceftizoxime,imipenem,piperacillin sulbactam and cefoperazone/sulbactam.Gram-positive bacteria were generally resistant to ampicillin and clindamycin,but were still relatively sensitive to vancomycin,teicoplanin and rifampin.Age,hepatic insufficiency,operation time,blood loss,transfusion factors,intraoperative injuries,left and right hepatic duct and postoperative T tube drainage were the independent risk factors of postoperative infections in patients with primary hepatic carcinoma（P〈0.05）.CONCLUSION The main pathogens causing postoperative infections in patients with primary hepatic carcinoma are gram-negative bacteria,we should choose ceftizoxime,imipenem,piperacillin sulbactam and cefoperazone/sulbactam and other sensitive drugs,and appropriate precautions should be taken according to the risk factors for infections.