卵巢癌患者术后切口感染的病原学分布、耐药性分析及相关影响因素分析

Analysis of the distribution and drug resistance of pathogens and relevant influencing factors in patients with a surgical site infection after surgery for ovarian cancer

目的探讨卵巢癌患者术后切口感染的病原菌分布、耐药情况,并分析相关影响因素。方法2013年4月至2018年5月江苏省无锡市中西医结合医院妇产科收入院的60例行外科手术治疗的卵巢癌患者,分为切口感染组(n=30)和未感染组(n=30)。采集感染组患者切口处分泌物标本检测病原菌分布及耐药情况。收集受检者临床资料,采用χ~2检验及Logistic回归法分析切口感染的相关危险因素。结果30例卵巢癌术后切口感染患者共检出52株病原菌,其中革兰阳性菌21株(占40.38%),以金黄色葡萄球菌和表皮葡萄球菌居多;革兰阴性菌30株(占57.69%),以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌居多。金黄色葡萄球菌和表皮葡萄球菌对青霉素、阿奇霉素及庆大霉素耐药率为30.00%~100.00%,对替考拉宁和万古霉素耐药率为0~9.09%。大肠埃希菌、铜绿假胞杆菌和肺炎克雷伯菌对头孢替坦、氨苄西林、氨苄西林/舒巴坦和头孢呋辛耐药率为60.00%~100.00%,对美罗培南、亚胺培南和万古霉素的耐药率为0~16.67%。χ^2检验及Logistic回归分析切口感染与年龄≥60岁、C反应蛋白≥10 mg/L、白蛋白≤30 g/L、合并糖尿病、未合理应用抗菌药物和手术时间较长有关(P<0.05)。其中年龄≥60岁、合并糖尿病、未合理应用抗菌药物和手术时间较长(≥250 min)均为切口感染的独立危险因素。结论卵巢癌患者术后切口感染病原菌以革兰阴性菌为主,该类菌对美罗培南、亚胺培南和万古霉素较敏感。年龄≥60岁、合并糖尿病、未合理应用抗菌药物和手术时间长是卵巢癌术后切口感染的独立危险因素,可为临床医生提供参考。

Objectives To investigate the distribution and drug resistance of pathogens causing a surgical site infection after surgery for ovarian cancer and to analyze related factors.Methods Clinical data on 60 patients with ovarian cancer who underwent surgery in Obstetrics and Gynecology at the Wuxi Hospital of Integrated Chinese and Western Medicine from April 2013 to May 2018 were collected.Patients were divided into those with an infection(n=30)and those without an infection(n=30).The distribution and drug resistance of pathogens were determined based on surgical site specimens from patients with an infection.Clinical data on subjects were collected,and the risk factors associated with a surgical site infection were analyzed using aχ~2 test and logistic regression analysis.Results A total of 52 pathogens were detected in 30 patients with a surgical site infection after surgery for ovarian cancer,including 21 strains of Gram-positive bacteria(40.38%).The main Gram-positive bacteria were Staphylococcus aureus and S.epidermidis.Thirty strains of Gram-negative bacteria(57.69%)were detected.The main Gram-negative bacteria were Escherichia coli,Pseudomonas aeruginosa,and Klebsiella pneumoniae.The resistance of S.aureus and S.epidermidis to penicillin,azithromycin,and gentamicin ranged from 30.00-100.00%,and their resistance to teicoplanin and vancomycin ranged from 0-9.09%.The resistance of E.coli,P.aeruginosa,and K.pneumoniae to cefotetan,ampicillin,ampicillin/sulbactam,and cefuroxime ranged from 60.00-100.00%.The resistance of those bacteria to meropenem,imipenem,and vancomycin ranged from 0-16.67%.Infection was associated with age≥60 years,C-reactive protein≥10 mg/L,albumin≤30 g/L,diabetes,irrational use of antibiotics,and a long operating time(P<0.05).Age≥60 years,diabetes,irrational use of antibiotics,and a long operating time(≥250 min)were independent risk factors for a surgical site infection.Conclusion The pathogens causing a surgical site infection in patients undergoing surgery for ovarian cancer were mainly Gram-negative bacteria,and those bacteria were sensitive to meropenem,imipenem,and vancomycin.Age≥60 years,diabetes,irrational use of antibiotics,and a long operating time were independent risk factors for a surgical site infection in patients undergoing surgery for ovarian cancer.This finding can serve as a reference for clinicians.