阑尾切除术后切口感染患者血清PCT、CRP、ESR水平及病原菌分布特征

Levels of serum PCT、CRP、ESR and distribution of pathogenic bacteria in patients with incision infection after appendectomy

目的分析阑尾切除术后切口感染患者血清降钙素原(PCT)、C-反应蛋白(CRP)、红细胞沉降率(ESR)水平、病原菌的分布及耐药特征。方法抽取2018年3月至2022年3月于临汾市人民医院行阑尾切除术后发生切口感染的70例患者为研究组,另抽取同期行阑尾切除术但术后切口未发生感染的70例患者为对照组。于术后48 h检测两组患者血清PCT、CRP、ESR水平;术后48 h,收集研究组患者的切口组织液送至实验室进行细菌培养和药敏试验。比较两组患者术后血清CRP、PCT、ESR水平,分析阑尾切除术后切口感染患者的病原菌分布及耐药特征。结果研究组患者血清CRP、PCT、ESR水平[(11.48±1.86)mg/L、(1.40±0.38)μg/L、(19.58±3.28)mm/h]均高于对照组[(2.26±0.35)mg/L、(0.41±0.07)μg/L、(5.78±0.98)mm/h],差异有统计学意义(P<0.05)。研究组70例标本中共检测出46株病原菌,革兰阴性菌30株,其中大肠埃希菌17株(37.0%),肺炎克雷伯菌5株(10.9%),铜绿假单胞菌5株(10.9%);革兰阳性菌16株,其中金黄色葡萄球菌5株(10.9%),粪肠球菌4株(8.7%),尿肠球菌3株(6.5%)。大肠埃希菌对厄他培南和美罗培南的敏感性较高;肺炎克雷伯菌对氨曲南、厄他培南、亚胺培南、美罗培南、哌拉西林/他唑巴坦敏感性较高;铜绿假单胞菌对氨曲南、厄他培南、亚胺培南、美罗培南敏感性较高。结论阑尾切除术后切口感染患者血清PCT、CRP、ESR水平会升高,可作为预判感染的重要指标,其主要病原菌为大肠埃希菌和肺炎克雷伯菌,可根据药敏结果合理选择抗生素。

Objective To analyze the levels of serum procalcitonin(PCT),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP),distribution of pathogenic bacteria,and the characteristics of drug resistance in patients with incision infection after appendectomy.Methods A total of 70 patients with incision infection after appendectomy treated in Linfen People’s Hospital from March 2018 to March 2022 were selected as the study group,at the same time,another 70 patients who underwent appendectomy without incision infection after operation during the same period were selected as the control group.The levels of serum PCT、CRP、ESR in the two groups were detected 48 hours after surgery.After 48 hours of surgery,the incision tissue fluid of the study group was collected and sent to the laboratory for bacterial culture and drug sensitivity testing.The postoperative levels of serum CRP,PCT,and ESR of the two groups were compared,moreover,the distribution and drug resistance characteristics of pathogens in patients with incision infection after appendectomy were analyzed.Results The levels of serum CRP,PCT,and ESR in the study group were(11.48±1.86)mg/L,(1.40±0.38)Mg/L,and(19.58±3.28)mm/h,respectively,which were higher than the(2.26±0.35)mg/L,(0.41±0.07)μg/L and(5.78±0.98)mm/h in the control group(P<0.05).A total of 46 strains of pathogenic bacteria were isolated from the 70 specimens of the study group;there were 30 strains of Gram-negative bacteria,including 17 strains(37.0%)of Escherichia coli,5 strains(10.9%)of Klebsiella pneumoniae,and 5 strains(10.9%)of Pseudomonas aeruginosa;there were 16 strains of Gram-positive bacteria,including 5 strains(10.9%)of Staphylococcus aureus,4 strains(8.7%)of Enterococcus faecalis,and 3 strains(6.5%)of Enterococcus faecium.Escherichia coli was highly sensitive to ertapenem and meropenem;Klebsiella pneumoniae was highly sensitive to aztreonam,ertapenem,imipenem,meropenem,piperacillin/tazobactam;Pseudomonas aeruginosa was highly sensitive to aztreonam,ertapenem,imipenem and meropenem.Conclusions The serum levels of PCT,CRP,and ESR in patients with incision infection after appendectomy increase,which can serve as important indicators for predicting infection.The main pathogens of incision infection after appendectomy include Escherichia coli and Klebsiella pneumoniae.Antibiotics can be reasonably selected according to results of drug sensitivity.