胃肠外科患者术后感染危险因素及病原菌药敏试验分析

Analysis of risk factors of postoperative infection and drug sensitivity test of pathogens in patients with gastrointestinal surgery

目的探究胃肠外科患者术后发生医院感染的危险因素,分析病原菌的药敏试验结果,为临床应用抗菌药物提供参考。方法前瞻性分析南通大学附属海安医院胃肠外科手术患者发生医院感染的资料,确定患者感染的独立危险因素,对感染患者的主要致病菌进行药敏试验分析。结果共收集手术患者518例,糖尿病、手术时间>120 min、Ⅲ类切口、急诊手术、保留引流管是患者感染的独立危险因素。共分离出病原菌90株,其中革兰阴性菌54株,主要为大肠埃希菌和铜绿假单胞菌;革兰阳性菌27株,主要为金黄色葡萄球菌。大肠埃希菌对头孢唑林耐药率为62.50%;铜绿假单胞菌对哌拉西林/他唑巴坦和头孢唑林耐药率为64.29%;金黄色葡萄球菌对头孢唑林的耐药率为58.33%。结论胃肠外科手术患者易发生感染,且感染患者病原菌对头孢唑林耐药率较高,临床医生应根据药敏试验结果选择合适的抗菌药物进行治疗。

Objective To explore the risk factors of nosocomial infection in patients with gastrointestinal surgery,and analyze the results of drug sensitivity tests of pathogenic bacteria,so as to provide a theoretical basis for the clinical application of antibiotics.Methods The data of nosocomial infections in patients with gastrointestinal surgery in Ha’an Hospital Affiliated to Nantong University was analyzed prospectively to determine the independent risk factors for infections,and the drug sensitivity test on the main pathogens of infected patients was conducted.Results A total of 518 surgical patients were collected.Diabetes,operation time>120 min,typeⅢincision,emergency operation and catheter retention were independent risk factors for patient infection.A total of 90 strains of pathogenic bacteria were cultured,of which 54 strains were Gramnegative bacteria,the were mainly Escherichia coli and Pseudomonas aeruginosa;27 strains were Gram-positive bacteria,that were mainly Staphylococcus aureus.The resistance rate of Escherichia coli to cefazolin was 62.50%,and the resistance rate of Pseudomonas aeruginosa to piperacillin/tazobactam and cefazolin was 64.29%;the resistance rate of Staphylococcus aureus to cefazolin was 58.33%.Conclusion Patients with gastrointestinal surgery are prone to infection,and the pathogens in infected patients have a high resistance rate to cefazolin.Clinicians should choose appropriate antibiotics for treatment according to the results of drug sensitivity tests.