结肠癌根治术患者术后切口感染病原菌及影响因素分析

Pathogenic bacteria and risk factors of incision infections after radical resection of colon cancer

目的探讨结肠癌根治术术后切口感染病原菌及影响因素,为临床治疗和防治提供一定参考价值。方法选取于2010年6月-2017年8月医院收治的结肠癌根治术患者893例为研究对象。采集结肠癌切口感染患者深部切口处的脓液与浅部切口处脓性分泌物,应用全自动微生物分析仪进行病原菌分析鉴定和药敏试验,统计分析结肠癌根治术术后切口感染的影响因素,包括年龄、性别、体质量指数、手术时间、合并糖尿病、血红蛋白、白蛋白、手术方法、术中出血量、手术位置、使用抗菌药物。结果 893例行根治术结肠癌患者中术后切口感染患者60例,感染率为6.72%;60例术后切口感染患者共分离培养病原菌76株,其中革兰阴性菌48株占63.16%、革兰阳性菌23株占30.26%、真菌5株占6.58%;大肠埃希菌对环丙沙星和头孢曲松耐药株数较多,肺炎克雷伯菌对头孢他啶和美罗培南耐药株数较多;多因素Logistic回归分析结果显示,手术时间≥3h、合并糖尿病、白蛋白<35g/L、手术方法为开腹及未使用抗菌药物为结肠癌术后切口感染的影响因素。结论结肠癌根治术术后切口感染病原菌主要为革兰阴性菌,其感染因素较多,应引起重视,按照其相关感染因素进行合理有效的防治工作,且合理应用抗菌药物,降低术后切口感染。

OBJECTIVE To investigate the pathogenic bacteria and risk factors of incisions infection after radical resection of colon cancer,so as to provide some reference value for clinical treatment.METHODS A total of 893 patients with colon cancer treated in our hospital from Jun.2010 to Aug.2017 were selected as the study subjects.Purulent secretions from deep incision and superficial incision were collected from patients with colon cancer incision infections for analysis,identification and drug sensitivity test by VITEK-2.The risk factors of incision infections after radical resection of colon cancer were analyzed,including age,gender,body mass index,operation time,combined diabetes,hemoglobin,albumin,surgical methods,intraoperative bleeding,surgical location,and antibiotic use.RESULTS Totally 60 cases were infected by incisional wound among 893 cases of patients underwent radical resection for colon cancer,and the infection rate was 6.72%.There were 76 pathogens isolated from 60 cases of incisional wound infection,among which 48 strains were gram-negative bacteria（63.16%）,23 strains were gram-positive bacteria（30.26%）,and 5 strains were fungi（6.58%）.Escherichia coli was highly resistant to ciprofloxacin and ceftriaxone,and Klebsiella pneumoniae was highly resistant to ceftazidime and meropenem.Multi-variable logistic regression analysis showed that operation time≥3 h,diabetes mellitus,albumin35 g/L,operation method of open and antibiotic use were independent risk factors for wound infectionS after colon cancer surgery.CONCLUSIONThe pathogens of incision infection after radical operation of colon cancer are mainly gramnegative bacteria,and there are many infection factors.We should pay attention to reasonable and effective prevention and control work in accordance with the related factors of infections,drugs and rational use of antibiotics,so as to reduce postoperative wound infections.