阑尾炎患者术后创口细菌感染特征及耐药性分析

Drug resistance and characteristics of bacterial infection in wounds after appendicitis surgery

目的探究急性阑尾炎患者术后切口细菌感染的细菌谱及药物敏感情况。方法选择2015年1月至2019年1月于我院行阑尾切除术后切口感染的66例患者作为研究对象,分析其伤口分泌物细菌培养结果和病原菌药敏情况。结果送检的66例标本中共有59例检出细菌,共分离病原菌15种,66株;其中有7例标本为两种细菌混合感染。检出的细菌中,革兰阳性菌39株,革兰阴性菌27株,其中革兰阳性菌以金黄色葡萄球菌、化脓性链球菌、溶血葡萄球菌为主;革兰阴性菌以大肠埃希菌、阴沟肠杆菌、铜绿假单胞菌为主。药敏试验显示,主要革兰阳性菌对头孢唑林、头孢拉定的敏感性较低,而对氨苄西林、阿莫西林、头孢他啶、头孢噻肟、美罗培南、亚胺培南以及利奈唑胺均具有较高的敏感性。主要革兰阴性菌对氨苄西林、阿莫西林、头孢唑林、头孢拉定以及头孢噻肟均不敏感,对头孢他啶、美罗培南、亚胺培南的敏感率大于50.00%,具有较高的敏感性。结论对于阑尾炎术后切口感染的患者,应加强无菌操作和病房环境清洁,在药敏试验结果明确前,建议使用头孢他啶或相对应的第三代头孢菌素进行抗感染治疗。

Objective To investigate the bacterial spectrum and drug resistance of post-operative bacterial infection in incision of patients with acute appendicitis.Methods Sixty-six patients with incision infection after appendectomy from January 2015to January 2019were included as study subjects,and the results of bacterial culture and drug sensitivity of pathogens in wound secretions were analyzed.Results Fifty-nine out of 66samples were positive,among which 15species and 66strains of bacteria were isolated,including 7cases of mixed infection by two species.Among the isolated bacterial strains,39were Gram-positive and 27were Gram-negative.Staphylococcus aureus,Streptococcus pyogenes and Staphylococcus haemolyticus were the main Gram-positive bacteria,while Escherichia coli,Enterobacter cloacae and Pseudomonas aeruginosa were the main Gram-negative bacteria.The main Gram-positive bacteria were less sensitive to Cefazolin and Cefradine,but more sensitive to Ampicillin,Amoxicillin,Ceftazidime,Cefotaxime,Meropenem,Imipenem and Linezolid.However,the main Gram-negative bacteria were not sensitive to Ampicillin,Amoxicillin,Cefazolin,Cefradine and Cefotaxime,and were more than 50.00%sensitive to Ceftazidime,Meropenem and Imipenem.Conclusion For patients with incision infection after appendicitis operation,aseptic operation and clean ward environment should be strengthened.Ceftazidime or appropriate third generation Cephalosporins should be used for anti-infection treatment before the drug sensitivity test results are confirmed.