结肠癌伴肠梗阻患者术后切口感染的病原菌分布及相关因素分析

Distribution of pathogens causing postoperative incision infections in colon cancer patients complicated with intestinal obstruction and related factors

目的研究分析结肠癌伴肠梗阻患者术后切口感染的病原菌分布及相关因素,为患者的治疗与预防提供参考。方法选取2013年1月-2017年1月医院收治的349例结肠癌伴肠梗阻手术治疗患者,所有患者的临床资料应用自制表格收集,采集切口感染浅部脓性分泌物或者切口深部的脓液进行细菌培养试验,抗菌药物耐药性应用K-B法。结果 349例结肠癌伴肠梗阻手术治疗患者中发生医院感染62例,感染率为17.77%,62例切口感染患者共分离病原菌169株,其中革兰阳性菌47株,占27.81%,主要为金黄色葡萄球菌,占20.12%,革兰阴性菌108株,占63.91%,主要为大肠埃希菌,占36.09%,真菌14株,占8.28%;金黄色葡萄球菌对阿莫西林、阿米卡星、头孢噻肟、苯唑西林、左氧氟沙星的耐药率均较高;大肠埃希菌对氨苄西林、头孢他啶、头孢唑林、头孢吡肟、左氧氟沙星、头孢哌酮/他唑巴坦的药物耐药性均较高;单因素分析显示体质量指数、年龄、伴有吸烟史和糖尿病史、开腹手术治疗、手术时间>80min、术后留置导尿管时间>3d、住院时间>10d是患者术后切口感染的相关因素(P<0.05);多因素Logistic分析显示年龄>60岁、伴有吸烟史和糖尿病史,开腹手术、术后留置导尿管时间>3d、住院时间>10d等均为术后切口感染的影响因素(P<0.05)。结论结肠癌伴肠梗阻患者术后切口感染的相关因素较多,应根据相关因素进行预防,并合理选择抗菌药物治疗,提高患者治疗疗效。

OBJECTIVE To investigate the distribution of pathogens causing postoperative incision infections in colon cancer patients complicated with intestinal obstruction and analyze the related risk factors so as to provide guidance for treatment and prevention.METHODS A total of 349 colon cancer patients complicated with intestinal obstruction who received surgical procedures from Jan 2013 to Jan 2017 were enrolled in the study,the clinical data of all the patients were collected by using self-designed forms,the superficial purulent secretions of incision infection or pus specimens of deep incision were collected for bacterial cultures,and the drug susceptibility testing was performed with the use of K-B method.RESULTS Of the 349 colon cancer patients complicated with intestinal obstruction,62 had nosocomial infection,with the infection rate 17.77%.Totally 169 strains of pathogens were isolated from the 62 patients with incision infection,47（27.81%）of which were gram-positive bacteria,108（63.91%）were gram-negative bacteria,and 14（8.28%）were fungi.Staphylococcus aureus was the predominant species of gram-positive bacteria,accounting for 20.12%;Escherichia coli was dominant among the gram-negative bacteria,accounting for 36.09%.The S.aureus strains were highly resistant to amoxicillin,amikacin,cefotaxime,oxacillin and levofloxacin;the E.coli strains were highly resistant to ampicillin,ceftazidime,cefazolin,cefepime,levofloxacin and cefoperazone-tazobactam.Univariate analysis showed that the related factors for the postoperative incision infection in the patients included body mass index,age,smoking history,diabetes mellitus history,laparotomy,operation duration more than 80 min,postoperative catheter indwelling time more than 3 days and length of hospital stay more than 10 days（P〈0.05）.Multivariate logistic analysis indicated that the influencing factors for the postoperative incision infections included the more than 60 years of age,smoking history,diabetes mellitus history,laparotomy,postoperative catheter indwelling time more than 3 days and length of hospital stay more than 10 days（P〈0.05）.CONCLUSION There are a variety of related factors for the postoperative incision infections in the colon cancer patients complicated intestinal obstruction.It is necessary to take prevention measures according to the related factors and reasonably use antibiotics so as to improve the treatment efficacy.