乳腺癌根治术后皮瓣下积液感染病原学特点及相关因素分析

Pathogenic characteristics and risk factors of infections of skin flap after radical mastectomy for breast cancer

目的分析乳腺癌患者根治术后皮瓣下积液感染的病原菌状况及相关因素。方法选择医院2014年1月-2015年8月的200例乳腺癌患者(根治术后的实际情况),提取患者感染部位分泌物进行病原菌培养,分析病原菌的种类及耐药性,并对患者年龄、抗菌药物使用、手术时长、手术创面、引流以及营养状况等潜在影响因素进行分析。结果 200例乳腺癌患者中有29例术后出现感染,感染率为14.50%,以坏死性蜂窝组织炎为主。感染患者分泌物共分离培养病原菌41株,其中革兰阳性菌28株占68.29%,以金黄色葡萄球菌为主;革兰阴性菌12株占29.27%,以肺炎克雷伯菌和大肠埃希菌为主;真菌1株占2.44%。药敏结果显示,金黄色葡萄球菌对万古霉素耐药性为零,对红霉素、庆大霉素的耐药性较高;肺炎克雷伯菌对头孢他啶、红霉素等药物耐药性较高,对亚胺培南耐药性为零;体重指数、合并症、引流方式及术中使用生物蛋白是导致乳腺癌患者术后发生皮瓣下积液感染的相关因素(P<0.05)。结论乳腺癌根治术后皮瓣下积液感染会引起患者身体病变或恶化,术前引导患者血糖和体质量控制,术后选择合理的引流方式,做好预防处理,从源头上抑制病原菌滋生,选择敏感抗菌药物,有利于降低感染率、提高手术成功率。

OBJECTIVE To analyze pathogenic factors and risk factors of infections of skin flap after radical mastec- tomy for breast cancer. METHODS A total of 200 breast cancer patients who were treateal in the hospital from Jan. 2014 to Aug. 2015 were enrollud in the study （according to the actual situation after radical mastectomy）, the in- fection site secretions were extracted and pathogenic bacteria were cultured, the species and drug resistance of pathogens were analyzed, and the potential factors such as age, antibiotic use, length of operation, surgical wound, drainage and nutritional status, as well as multiple factors were analyzed.RESULTS In 200 cases of breast cancer, 29 cases had postoperative infections, the infection rate was 14.50%, and the main infection site necrotic eellulitis. There were 41 strains of pathogenic bacteria isolated from secretions of infected patients, including 28 strains of gram-positive bacteria, accounting for 68.29%, mainly Staphylococcus aureus, 12 strains of gram-nega- tive bacteria, accounting for 29.27%, mainly Klebsiella pneumoniae and Escherichia coli, and 1 strain of fungi, accounting for 2.44%. The results of susceptibility test showed that Staphylococcus aureus was sensitive to vanco- mycin, had high resistant rates to erythromyein, gentamicin and gentamycin, and Klebsiella pneumoniae had high resistance to ceftazidime and erythromycin, was sensitive to imipenem. Body mass index （BMI）,complication, drainage and intraoperative use of biological protein were independent risk factors for postoperative fluid accumulation infection in the flap in patients with breast cancer（P〈0.05）.CONCLUSION After radicaI mas- tectomy, effusion under skin flap infection can cause the patienttsbody lesions or deterioration, and factors of in- fections are complex, preoperative control of blood glucose and body weight in patients , choosing a reasonable way of postoperative drainage, prevention and treatment, inhibiting pathogen growth from the source, and selec- tion of sensitive antibiotics, can reduce infection rate, and improve the success rate of operation.