179例结直肠手术术后腹腔感染患者的病原学特点及用药分析

Etiological Characteristics and Medication Analysis of 179 Patients with Intra-Abdominal Infections After Colorectal Surgery

目的:探讨结直肠手术术后腹腔感染患者的病原学特点及用药治疗策略。方法:对2013—2022年北京市健宫医院结直肠手术术后确诊腹腔感染的179例患者的病历资料进行回顾性分析。结果:179例结直肠手术术后腹腔感染患者中,男性患者107例,女性患者72例;平均年龄为(60.72±13.40)岁;共培养出病原菌211株,其中革兰阴性菌141株、革兰阳性菌67株、真菌3株,分别占66.82%、31.75%、1.42%;菌株数排序居前3位的分别为大肠埃希菌、屎肠球菌和肺炎克雷伯菌;共培养出74株产超广谱β-内酰胺酶大肠埃希菌、3株耐碳青霉烯类肺炎克雷伯菌、12株耐万古霉素肠球菌、6株耐甲氧西林金黄色葡萄球菌;腹腔感染用药选择中,排序居前5位的分别为头孢哌酮舒巴坦、亚胺培南、头孢曲松、万古霉素和替加环素;65例患者采用联合用药方案,占36.31%;经过治疗,173例患者痊愈出院,救治成功率达96.65%。结论:结直肠手术术后腹腔感染的病原菌以革兰阴性菌为主,且耐药性较高,临床在选择经验性药物治疗时,应针对耐药菌株且必要时采取联合用药;药师应积极参与药物治疗管理,协助临床做好患者诊疗工作。

OBJECTIVE:To probe into the pathogenic characteristics and medication treatment strategies of patients with abdominal infection after colorectal surgery.METHODS:A total of 179 patients with intra-abdominal infections after colorectal surgery from^(2)013 to 2022 in Beijing Jiangong Hospital were retrospectively collected.RESULTS:Of the 179 patients with intra-abdominal infection after colorectal surgery,107 were males and 72 were females.The average age was(60.72±13.40)years.A total of 211 strains of pathogenic bacteria were cultured,in 179 patients,including 141 strains of Gram-negative bacteria,67 strains of Gram-positive bacteria and 3 strain of fungi,accounting for 66.82%,31.75%and 1.42%,respectively.The top three strains were Escherichia coli,Enterococcus faecium and Klebsiella pneumoniae.A total of 74 strains were isolated producing extended spectrumβ-lactamase E.coli,3 strains of K.pneumoniae resistant to carbapenems,12 strains of Enterococcus resistant to vancomycin and 6 strains of Staphylococcus aureus resistant to methicillin.The top five antimicrobials for intra-abdominal infection were cefoperazone/sulbactam,imipenem,ceftriaxone,vancomycin and tegacyclin.Totally 65 patients were treated with combination regimen,accounting for 36.31%.And 173 cases were cured and discharged after treatment,with the cure rate of 96.65%.CONCLUSIONS:The pathogens of intra-abdominal infection after colorectal surgery are mainly Gram-negative bacteria with high drug resistance.The selection of empirical treatment drugs should be targeted at drug-resistant strains,and combination regimen should be applied when necessary.Pharmacists should actively participate into the management of drug treatment and assist in the clinical diagnosis and treatment of patients.