结直肠癌术后切口医院感染的影响因素及病原学特点

Influencing factors for postoperative incision infections in patients with colorectal cancer and etiological characteristics

目的分析结直肠癌术后切口医院感染的影响因素及病原学特点。方法选择医院2014年1月-2016年12月收治的行结直肠癌手术患者335例,依据术后是否发生切口医院感染,分为感染组86例与未感染组249例,分析结直肠癌患者术后切口医院感染的影响因素及病原学特点。结果 86例术后发生切口医院感染患者分泌物培养共检出病原菌134株,其中革兰阴性菌78株占58.21%,革兰阳性菌46株占34.33%,真菌10株占7.46%;主要革兰阴性菌中大肠埃希菌及铜绿假单胞菌对美罗培南及亚胺培南的耐药率为0,对氨苄西林耐药性较强,主要革兰阳性菌金黄色葡萄球菌对万古霉素、替考拉宁、利奈唑胺具有较好的药物敏感性,对阿莫西林具有较高的耐药性;患者的年龄≥60岁、手术方式采用开腹术、手术时间≥1.5h、既往有腹部手术史、合并糖尿病是结直肠癌患者术后发生切口医院感染的独立影响因素。结论引起结直肠癌术后发生切口医院感染的因素较为复杂,临床上需综合评估患者术前情况,尽量采用腹腔镜术式,减少手术时间、控制好血糖水平,以期降低术后切口医院感染的可能。

OBJECTIVE To investigate the influencing factors for postoperative incision infections in patients with colorectal cancer and analyze the etiological characteristics.METHODS A total of 335 patients with colorectal cancer who received surgical procedures from Jan 2014 to Dec 2016 were enrolled in the study and divided into the infection group with 86 cases and the non-infection group with 249 cases according to the status of incision infections.The influencing factors for the postoperative incision infection and the etiological characteristics were observed.RESULTS Totally 134 strains of pathogens were isolated from wound secretions that were obtained from 86 patients with postoperative incision infections,78（58.21%）of which were gram-negative bacteria,46（34.33%）were gram-positive bacteria and 10（7.46%）were fungi.Among the gram-negative bacteria,the drug resistance rates of Escherichia coli and Pseudomonas aeruginosastrains to meropenem and imipenem were 0,and the strains were highly resistant to ampicillin.Among the gram-positive bacteria,the Staphylococcus aureus strains were highly susceptible to vancomycin,teicoplanin and linezolid but were highly resistant amoxicillin.The no less than60 years of age,laparotomy,operation duration no less than 1.5 hours,previous history of abdominal surgery and complication with diabetes mellitus were the independent influencing factors for the postoperative incision infections in the patients with colorectal cancer.CONCLUSION The factors for the postoperative incision infections are so complex that the hospital should estimate the preoperative condition of the patients,try to carry out the laparoscopic surgery,shorten the operation duration and control the level of blood glucose so as to reduce the risk of postoperative incision infections.