宫颈癌患者术后医院感染病原菌、耐药性情况及危险因素分析

Pathogens causing a nosocomial infection in patients after surgery for cervical cancer, their drug resistance, and risk factors for development of an infection

目的检测宫颈癌患者术后医院感染病原菌分布并进行耐药性和危险因素分析,为临床合理使用抗菌药物以及制定适宜的预防方案提供参考。方法 2013年1月至2018年5月在本院行宫颈癌根治术且术后发生医院感染的患者308例,对感染的病原菌进行分离、培养鉴定并进行药敏试验,分析病原菌的分布和耐药情况,并分析发生医院感染的危险因素。结果宫颈癌术后发生医院感染308例患者,感染主要部位是泌尿道(占37.21%)以及手术切口(占28.58%)。308例患者共检出病原菌457株,其中革兰阴性菌(G^-菌)271株,占59.30%;革兰阳性菌(G^+菌)164株,占35.89%;真菌22株,占4.81%。对病原菌作药敏试验,G^-菌中的大肠埃希菌对头孢吡肟、氨苄西林等8种抗菌药物的耐药率为29.70%~97.03%,对替考拉宁和亚胺培南敏感;肺炎克雷伯菌对阿米卡星、氨苄西林等8种抗菌药物的耐药率为19.74%~86.84%,对替考拉宁、亚胺培南、头孢吡肟的耐药率为0~9.21%;铜绿假单孢菌对氨曲南、阿米卡星的耐药率为17.85%~69.64%,对替考拉宁、氨苄西林等6种抗菌药物的耐药率为0~8.93%。G^+菌中的金黄色葡萄球菌、粪肠球菌对青霉素G、红霉素、克林霉素、四环素、左氧氟沙星的耐药率为10.00%~96.97%,对氨苄西林、利奈唑胺、万古霉素、亚胺培南的耐药率为0~8.51%。宫颈癌切除术患者的年龄、住院时间、引流管留置时间、手术操作方法是术后发生医院感染的相关危险因素(P<0.05)。结论宫颈癌患者术后感染的病原体分布较广,细菌是主要感染原,且对部分抗菌药物存在一定的耐药性。开展病原学检查并明确其发生感染的相关危险因素,对于合理应用抗菌药物和采取相应措施预防感染的发生具有重要的临床意义。

Objectives To determine the distribution of pathogens causing a nosocomial infection in patients after surgery for cervical cancer, to analyze their drug resistance, and to analyze risk factors for development of an infection in order to provide as reference for rational use of antibiotics in clinical settings and formulation of appropriate preventive and therapeutic strategies. Methods Subjects were 308 patients with cervical cancer who underwent radical surgery at this Hospital and who developed a nosocomial infection from January 2013 to May 2018. Pathogens were isolated, cultured, identified, and subjected to drug susceptibility testing. The distribution and drug resistance of pathogens and risk factors for development of a nosocomial infection were analyzed. Results In the 308 patients who developed a nosocomial infection after surgery for cervical cancer, the main site of infection was the urinary tract(37.21%) and the surgical site(28.58%). A total of 457 strains of pathogens were detected in the 308 patients, including 271 strains of Gram-negative bacteria(59.30%), 164 strains of Gram-positive bacteria(35.89%), and 22 strains of fungi(4.81%). Pathogens were subjected to drug susceptibility testing. The resistance of the Gram-negative bacterium E. coli to 8 antimicrobials such as cefepime and ampicillin was 29.70-97.03%, and its resistance to teicoplanin and imipenem was 0%. The resistance of Klebsiella pneumoniae to 8 antimicrobials such as amikacin and ampicillin was 19.74-86.84%, and its resistance to teicoplanin, imipenem, and cefepime was 0-9.21%. The resistance of Pseudomonas aeruginosa to aztreonam and amikacin was 17.85% to 69.64%, and its resistance to 6 antimicrobials such as teicoplanin and ampicillin was 0-8.93%. The resistance of the Gram-positive bacteria Staphylococcus aureus, and Enterococcus faecalis to penicillin G, erythromycin, clindamycin, tetracycline, and levofloxacin was 10.00-96.97%, and their resistance to ampicillin, linezolid, vancomycin, and imipenem was 0-8.51%. Age, duration of hospitalization, duration of drainage tube placement, and the procedure used were risk factors related to the development of a nosocomial infection in patients who underwent surgery for cervical cancer(P<0.05). Conclusion A wide variety of pathogens caused a nosocomial infection in patients after surgery for cervical cancer. Infections were mainly caused by bacteria. Some of the pathogens were drug-resistant to an extent. Exploring the etiology of and risk factors for development of an infection has crucial clinical significance in terms of the rational use of antibiotics and corresponding infection control measures.