绝经后期子宫肌瘤切除术后切口感染病原菌与耐药性及其抗菌疗效

Pathogenic bacteria,drug resistance in postoperative incisional infection and their antibacterial efficacy in patients undergoing myomectomy in late menopause

目的 探讨绝经后期子宫肌瘤切除术后切口感染病原菌、耐药特征及抗菌疗效。方法 选取2019年10月-2022年10月于浙江大学医学院附属第二医院临平院区行子宫肌瘤切除术后发生切口感染的绝经后期患者96例,采集感染部位分泌物,采用全自动微生物分析仪进行病原菌分离鉴定和药敏试验。采用随机数字表法将患者分为研究组和对照组,每组48例。研究组给予注射头孢哌酮/舒巴坦治疗,对照组给予注射用左氧氟沙星治疗,均治疗7 d。酶联免疫吸附法检测患者治疗前后血清C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)和IL-6。对比两组患者治疗后病原菌清除率和不良反应。结果 96例患者样本经病原菌培养,共分离出79株病原菌(82.29%),以金黄色葡萄球菌(21.52%)和大肠埃希菌(26.58%)为主。大肠埃希菌对氨苄西林、头孢吡肟和氨曲南耐药率最高,而铜绿假单胞菌对氨苄西林和磺胺甲噁唑/甲氧苄啶耐药率最高(均为100.00%)。金黄色葡萄球菌对红霉素耐药率最高(94.12%);表皮葡萄球菌对青霉素、红霉素和克林霉素耐药率最高(100.00%);治疗后,研究组血清CRP、TNF-α、IL-8和IL-6均低于对照组(均P<0.05);两组不良反应发生率差异无统计学意义(P=0.442);研究组病原菌总清除率(75.00%)高于对照组(54.17%)(P=0.033)。结论 绝经后期子宫肌瘤切除术患者术后切口感染病原菌种类较多,对常用抗菌药物耐药性高,头孢哌酮/舒巴坦治疗患者术后感染的效果优于左氧氟沙星,两者安全性均较好。

OBJECTIVE To investigate the pathogenic bacteria,drug resistance characteristics and antibacterial efficacy in postmenopausal patients with incision infection after myomectomy.METHODS Ninety-six cases of late menopausal patients with incisional infection after myomectomy at the Second Hospital of Zhejiang University School of Medicine Linping Campus from Oct.2019 to Oct.2022 were selected,and the secretions from the infected site were collected and the pathogenic bacteria were isolated and identified and tested for drug sensitivity using a fully automated microbiological analyzer.The patients were divided into the study group and the control group using the random number table method,with 48 cases in each group.The study group was treated with injectable cefoperazone sodium sulbactam and the control group was treated with injectable levofloxacin,both for 7 d.Serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-8(IL-8) and IL-6 were measured by enzyme-linked immunosorbent assay before and after treatment.The clearance rates of pathogenic bacteria and adverse effects were compared between the two groups.RESULTS A total of 79(82.29%) strains of pathogens were isolated from 96 patients′ samples by pathogenic bacterial culture,dominated by Staphylococcus aureus(21.52%) and Escherichia coli(26.58%).Escherichia coli had the highest resistant rates to ampicillin,cefepime and aztreonam,while Pseudomonas aeruginosa had the highest resistant rates to ampicillin and compound sulfamethoxazole(both 100.00%).Staphylococcus aureus had the highest rate of resistance to erythromycin(94.12%).Staphylococcus epidermidis had the highest rate of resistance to penicillin,erythromycin and clindamycin(100.00%).After treatment,levels of serum CRP,TNF-α,IL-8 and IL-6 in the study group were lower than those in the control group(P<0.05).The difference in the incidence of adverse reactions between the two groups was not statistically significant(P=0.442);the overall clearance rate of pathogens was higher in the study group(75.00%) than in the control group(54.17%)(P=0.033).CONCLUSION There were a wide variety of pathogens in postmenopausal patients with incision infection after myomectomy,with high resistant rates to commonly used antibiotics.The curative effect of cefoperazone/sulbactam sodium was superior to that of levofloxacin in treating postoperative infection in patients,and safety of the two methods was high.