胆石症术后腹腔感染的病原菌分布及其危险因素分析

Pathogen Distribution and Risk Factors of Postoperative Abdominal Infections in Patients with Cholelithiasis

目的探讨胆石症患者术后腹腔感染病原菌的分布、药敏情况,并分析引起感染的危险因素。方法选取行手术治疗的胆石症366例,其中发生术后腹腔感染的69例作为研究对象,调查感染病原菌的分布和药敏情况,分析感染的患者因素和医源性因素。结果共分离到病原菌91株,其中革兰阴性菌72株(79.12%)、革兰阳性菌17株(18.68%)、真菌2株(2.20%);较常见的病原菌依次为大肠埃希菌37株(40.66%)、铜绿假单胞菌19株(20.88%)、肺炎克雷伯菌和肠球菌属各9株(9.89%)。术后感染的革兰阴性菌仅对亚胺培南100%敏感,对阿米卡星的敏感率较高;革兰阳性菌对利奈唑胺100%敏感,对万古霉素的敏感率较高。患者的性别、年龄、合并基础疾病、术中损伤性操作、引流管放置及术后抗菌药物使用种类等因素均对胆石症术后腹腔感染的发生率有显著影响(P<0.05或P<0.01)。结论胆石症患者术后腹腔感染的发生与多种因素有关,应采取有针对性的干预措施,以减少术后并发症。

Objective To investigate the pathogen distribution, antibiotic resistance and risk factors of postoperative abdomi- nal infections in patients with cholelithiasis. Methods 366 patients with cholelithiasis were treated surgically, and 69 of them with postoperative abdominal infections were enrolled in this study. The distribution of pathogens, antibiotic resistance and such risk factors as physical factors or tatrogenic factors were investigated. Results A total of 91 bacterial strains were isolated, including 72 Gram-neg- ative （79.12%）, 17 Gram-positive （18.68%） and 2 fungal strains （2.20%）. The top four strains were Escberichia coli （37, 40.66% ）, Pseudomonas aeruginosa （ 19, 20.88% ）, Klebsiella pneumonia （9, 9.89% ） and Enterococcus （9, 9.89% ）, respec- tively. None of the Gram-negative strains was resistant to imipenem and all of them showed a high susceptibility to amikacin. None of the Gram-positive strains was resistant to linezolid and all of them showed a high susceptibility to vancomycin. The results showed that some factors, including the gender or age of patients, complications with other diseases, perioperative damage, drainage tubes, and types of postoperative antibiotics, had significant impact on the incidence of postoperative abdominal infections in cholelithiasis patients （ P 〈 0.05 or P 〈 0.01 ）. Conclusions Many risk factors are involved in postoperative abdominal infections among patients with chole- lithiasis. Some effective interventions should be enforced to reduce the incidence of postoperative infections and postoperative complica- tions in patients.