胸外科患者术后医院感染病原菌分布及耐药情况

Distribution of pathogenic bacteria and drug resistance in patients with postoperative nosocomial infections in Department of Thoracic Surgery

目的分析胸外科患者术后医院感染病原菌分布及耐药情况。方法检索中国知网数据库、万方数据库等相关数据库收录的近10年内发表的有关胸外科患者术后医院感染病原菌检测或药敏试验的中文文献,对所涉及患者的相关资料及数据进行筛选及分析。结果本研究共纳入符合条件的文献22篇。12938例手术患者中,2562例发生术后感染,最常累及感染部位为呼吸系统。检测出病原菌3157株,其中革兰氏阴性菌2230株(70.64%),检出前2位的为铜绿假单胞菌、肺炎克雷伯菌,分别占19.90%、15.68%;革兰氏阳性菌749株(23.73%),检出前2位的为金黄色葡萄球菌、肠球菌属,分别占9.72%、4.53%;真菌178株(5.64%)。药物敏感试验结果显示,革兰氏阴性菌对阿米卡星、亚胺培南等抗菌药物具有良好的敏感性,对磺胺类抗菌药物普遍耐药;革兰氏阳性菌对磺胺甲噁唑/甲氧苄啶及万古霉素等抗菌药物具有良好的敏感性,对青霉素及头孢等抗菌药物普遍耐药。结论胸外科术后感染的病原菌以革兰氏阴性菌为主,真菌感染不容忽视。临床上应根据细菌培养及药敏试验结果选择合适的抗生素。

Objective To analyze the distribution of pathogenic bacteria and drug resistance in patients with postoperative nosocomial infections in Department of Thoracic Surgery.Methods The Chinese literatures about the detection of pathogenic bacteria or drug sensitivity test for postoperative nosocomial infection in patients with thoracic surgery published in recent 10 years were searched in CNKI database,Wanfang database and other relevant databases,and the relevant materials and data of the patients involved in literatures were screened and analyzed.Results A total of 22 qualified literatures were included in this study.Among 12938 cases with thoracic surgery,postoperative infections occurred in 2562 cases,and the most frequently involved infection site was respiratory system.Totally 3157 strains of pathogenic bacteria were detected,including 2230 strains of Gram-negative bacteria(70.64%)with the top two strains of pseudomonas aeruginosa(19.90%)and klebsiella pneumoniae(15.68%),749 strains of Gram-positive bacteria(23.73%)with the top two strains of staphylococcus aureus(9.72%)and enterococcus(4.53%),and 178 strains of fungi(5.64%).The results of drug sensitivity test showed that Gram-negative bacteria had good sensitivity to amikacin,imipenem and other antibiotics,and were generally resistant to sulfonamides,while Gram-positive bacteria had good sensitivity to sulfamethoxazole/trimethoprim and vancomycin,and were generally resistant to penicillin and cephalosporin.Conclusion Gram-negative bacteria are the main pathogen of postoperative infections in Department of Thoracic Surgery,and fungal infection should not be ignored.In clinical practice,we should choose appropriate antibiotics according to the results of bacterial culture and drug sensitivity test.