结直肠癌患者手术部位感染致病菌的分布及感染危险因素分析

Distribution of pathogenic bacteria and analysis of infection risk factors in surgical site infections of colorectal cancer patients

目的 探析结直肠癌患者合并术后手术部位感染致病菌分布特点及感染危险因素。方法 选取本院接受治疗的82例结直肠癌术后手术部位感染患者为研究对象,同时选取同期结直肠癌术后未发生感染患者80例为未感染对照组。回顾性分析两组患者临床资料,探讨影响术后合并手术部位感染的相关危险因素。无菌条件下,采集患者感染部位标本进行病原菌鉴定及药敏试验。结果 82例合并术后手术部位感染患者中,47.56%为直肠癌患者(39/82),52.44%为结肠癌患者(43/82),主要为浅部切口位置发生感染(81.71%,67/82)。共检出病原菌82株,68.29%为革兰阴性菌(56/82),主要为大肠埃希菌(24/82)。30.49%为革兰阳性菌(25/82),主要为表皮葡萄球菌(13/82)。药敏试验结果显示,大肠埃希菌对氨苄西林、头孢唑林、庆大霉素、左氧氟沙星的耐药率高于50%,分别为95.83%、79.17%、58.33%、54.17%。对头孢他啶、美罗培南、莫西沙星的耐药率低于30%,分别为25%、4.17%、20.83%,未产生对亚胺培南的耐药株。铜绿假单胞菌对对庆大霉素、左氧氟沙星的耐药率高于50%,分别为71.43%、64.29%,对头孢他啶、美罗培南、莫西沙星的耐药率低于30%,分别为28.57%、14.29%、21.43%,未产生对亚胺培南的耐药株。表皮葡萄球菌对青霉素G全部耐药,对红霉素、左氧氟沙星、庆大霉素、苯唑西林的耐药率高于50%,分别为92.31%、69.23%、53.85%、69.23%,未产生对万古霉素的耐药株。金黄色葡萄球菌对青霉素G全部耐药,对红霉素、左氧氟沙星、庆大霉素、苯唑西林、四环素的耐药率高于50%,分别为85.71%、71.43%、57.14%、85.71%、57.14%,对莫西沙星的耐药率为28.57%,未产生对万古霉素的耐药株。对比两组患者临床资料,进行单因素分析发现,BMI、合并糖尿病、手术方式、手术时间差异有统计学意义(均P<0.05)。多因素分析显示,BMI>24 kg/m2、手术类型为开腹手术、手术时间>4 h是结直肠癌患者合并术后手术部位感染的独立危险因素。结论 结直肠癌合并术后手术部位感染患者病原菌以革兰阴性菌为主,主要病原菌对常见抗菌药物的耐药性较高,临床上应根据药敏试验结果合理使用抗菌药物,降低多重耐药菌的发生率。结直肠癌合并术后手术部位感染的相关因素较多,临床可针对相关感染因素进行积极干预,预防感染的发生。

Objective The distribution characteristics and risk factors of pathogenic bacteria in postoperative surgical site infections in patients with colorectal cancer were analyzed.Methods 82patients with colorectal cancer complicated with postoperative surgical site infection who received treatment at our hospital were selected as the study subjects,while 80patients without postoperative infection during the same period were selected as the uninfected control group.The clini-cal data from two groups of patients were analyzed retrospective to explore relevant risk factors affecting postoperative complications of surgical site infections.Under sterile conditions,the samples of infected areas were collected from pa-tients for pathogen identification and drug sensitivity testing.Results Among 82patients with postoperative surgical site infections,47.56%were rectal cancer patients(39/82)and 52.44%were colon cancer patients(43/82),with the main infection occurring at the superficial incision site(81.71%,67/82).A total of 82pathogenic bacteria were detected,of which 68.29%were Gram negative bacteria(56/82),mainly Escherichia coli(24/82).30.49%are Gram positive bacteria(25/82),mainly Staphylococcus epidermidis(13/82).The drug sensitivity test showed that the resistance rate of E.coli to ampicillin,Cefazolin,Gentamicin and Levofloxacin was higher than 50%,which were 95.83%,79.17%,58.33%and 54.17%respectively.The drug resistance rate to Ceftazidime,Meropenem and Moxifloxacin was lower than 30%,which were 5%,4.17%and 20.83%,respectively.There was no drug resistance to Imipenem.The drug resistance rate of Pseudo-monas aeruginosa to Gentamicin and Levofloxacin was higher than 50%,71.43%and 64.29%respectively,while the drug resistance rate to Ceftazidime,Meropenem and Moxifloxacin was lower than 30%,28.57%,14.29%and 21.43%respec-tively.There was no drug resistance to Imipenem.S.epidermidis was all resistant to penicillin G.The resistance rate to Erythromycin,Levofloxacin,Gentamicin,and Oxacillin was higher than 50%,92.31%,69.23%,53.85%,and 69.23%,re-spectively.There was no resistance to Vancomycin.S.aureus was all resistant to penicillin G.The resistance rate to E-rythromycin,Levofloxacin,Gentamicin,Oxacillin,and tetracycline was more than 50%,85.71%,71.43%,57.14%,85.71%,and 57.14%,respectively.The resistance rate to Moxifloxacin was 28.57%,and there was no Vancomycin resistant strain.The clinical data of the two groups were compared,and univariate analysis showed that there were statistically sig-nificant differences in BMI,combined diabetes,operation mode,and operation time(all P<0.05).Multivariate analysis showed that BMI>24kg/m 2,surgical type open surgery,and surgical time>4hwere independent risk factors for postop-erative surgical site infection in colorectal cancer patients.Conclusion The pathogenic bacteria in patients with colorec-tal cancer complicated by postoperative surgical site infection were mainly Gram negative bacteria,and the main pathogenic bacteria had high resistance to common antibiotics.In clinical practice,antibiotics should be used reasonably based on the results of drug sensitivity tests to reduce the incidence of multidrug-resistant bacteria.There were many factors related to postoperative surgical site infection in colorectal cancer,and active intervention can be taken in clinical practice to prevent the occurrence of infection.