全身麻醉与腰椎麻醉患者术后发生医院感染病原体分布特点及耐药情况分析

Analysis of pathogens distribution and drug resistance in patients with nosocomial infection after general anesthesia and lumbar anesthesia

目的分析全身麻醉与腰椎麻醉患者术后医院感染病原体分布特点及耐药情况。方法选取2016年1月-2017年12月在本院进行手术治疗的患者160例为研究对象,其中进行全身麻醉手术的患者80例,采用腰椎麻醉的患者80例,观察2组患者术后医院病原体特点及耐药情况分析。结果全麻患者呼吸道感染率为14.0%,总感染率为18.0%,均高于腰椎麻醉患者呼吸道感染率(6.5%)和总感染率(10.5%),差异有统计学意义(P<0.05)。医院获得性肺炎患者痰标本中以铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌发病率较高,分别为34.1%、24.4%、21.9%。铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌对头孢他啶、头孢吡肟、庆大霉素、环丙沙星、头孢曲松、头孢噻肟均有较高的耐药率,铜绿假单胞杆菌对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦耐药率为16.7%,鲍曼不动杆菌对亚胺培南不耐药,大肠埃希菌对亚胺培南、头孢哌酮/舒巴坦不耐药。结论全身麻醉加重患者院内获得性肺炎的发生率,值得临床关注。

Objective To analyze the distribution and drug resistance of pathogens in patients with nosocomial infection after general anesthesia and lumbar anesthesia. Methods From January 2016 to December 2017,160 patients underwent surgical treatment in our hospital. Among them,80 patients underwent general anesthesia and 80 patients underwent lumbar anesthesia.The characteristics of pathogens and their drug resistance were analyzed. Results The respiratory infection rate in patients with general anesthesia was 14. 0%,and the total infection rate was 18. 0%,which were higher than that in lumbar anesthesia patients（6. 5%,10. 5%）. The differences were statistically significant（P〈0. 05）. The incidence rates of Pseudomonas aeruginosa,Acinetobacter baumannii,and Escherichia coli in patients with hospital-acquired pneumonia were higher（34. 1%,24. 4%,and 21. 9%,respectively）. Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli had high resistance to ceftazidime,cefepime,gentamycin,ciprofloxacin,ceftriaxone,and cefotaxime. The resistance rate of Pseudomonas spp. to cefoperazone/sulbactam and piperacillin/tazobactam was 16. 7%. Acinetobacter baumannii was not resistant to imipenem and Escherichia coli was not resistant to imipenem,cefoperazone/sulbactam. Conclusion General anesthesia aggravates the incidence of hospital acquired pneumonia,which is worthy of clinical attention.