胃肠疾病手术患者术后呼吸道感染的病原菌分布药敏性及影响因素分析

Analysis of Pathogen Distribution,Drug Sensitivity and Influencing Factors of Postoperative Respiratory Tract Infections in Patients with Gastrointestinal Surgery

目的:探讨胃肠疾病手术患者术后呼吸道感染的病原菌分布、药敏性及影响因素。方法:选取2019年4月至2023年4月105例胃肠疾病手术后呼吸道感染患者作为感染组,分析感染患者病原菌分布和药敏性。另取同期105例胃肠疾病手术后未发生呼吸道感染患者作为非感染组。收集两组一般资料,采用多因素Logistic回归分析探寻胃肠疾病手术患者术后呼吸道感染的风险因素。结果:105例感染组患者共从痰液样本中分离出121株病原菌,其中革兰阴性菌78株(64.46%),以铜绿假单胞菌为主;革兰阳性菌37株(30.58%),以金黄色葡萄球菌为主;真菌6株(4.96%),均为白假丝酵母菌;铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌及鲍曼不动杆菌对氨苄西林的耐药率均为100%;铜绿假单胞菌、肺炎克雷伯菌及大肠埃希菌对哌拉西林/他唑巴坦的耐药率分别为6.45%、15.00%、7.69%。金黄色葡萄球菌、溶血性葡萄球菌及表皮葡萄球菌对青霉素的耐药率分别为100%、90.00%、100.00%;金黄色葡萄球菌、溶血性葡萄球菌及表皮葡萄球菌对喹奴普丁/达福普丁的耐药率均为0.00%;两组在年龄、吸烟史、糖尿病、肺部疾病史、手术方式、手术性质、手术时间及留置胃管等方面比较,差异有统计学意义(P<0.05);二分类Logistic回归分析显示,吸烟史(OR=1.772,P=0.002)、糖尿病(OR=2.212,P<0.001)、肺部疾病史(OR=1.950,P=0.001)、开腹手术(OR=2.522,P<0.001)、急诊手术(OR=2.389,P<0.001)、手术时间≥2h(OR=2.102,P=0.002)及留置胃管(OR=1.857,P<0.001)均为胃肠疾病手术患者术后呼吸道感染的危险因素。结论:胃肠疾病手术患者术后呼吸道感染以革兰阴性菌为主,革兰阴性菌对氨苄西林具有较高的耐药性,革兰阳性菌对青霉素具有较高的耐药性,术后呼吸道感染的发生与多种风险因素有关。

Objective:To investigate the distribution of pathogens,drug sensitivity,and influencing factors of postoperative respiratory tract infections in patients undergoing gastrointestinal surgery.Methods:A total of 105 patients with postoperative respiratory tract infections after gastrointestinal surgery from April 2019 to April 2023 were selected as the infection group.The distribution and drug sensitivity of pathogens in infected patients were analyzed.Another 105 patients who did not develop respiratory tract infections after gastrointestinal surgery during the same period were selected as the non-infection group.General information was collected for both groups,and multifactor logistic regression analysis was used to explore the risk factors for postoperative respiratory tract infections in patients undergoing gastrointestinal surgery.Results:In the 105 patients of the infection group,a total of 121 strains of pathogens were isolated from sputum samples.Among them,78 strains(64.46%)were Gram-negative bacteria,mainly Pseudomonas aeruginosa;37 strains(30.58%)were Gram-positive bacteria,mainly Staphylococcus aureus;and 6 strains(4.96%)were fungi,all Candida albi-cans.Pseudomonas aeruginosa,Klebsiella pneumoniae,Escherichia coli,and Acinetobacter baumannii had a 100%resistance rate to ampicillin.The resistance rates of Pseudomonas aeruginosa,Klebsiella pneumoniae,and Escherichia coli to piperacillin/tazobactam were 6.45%,15.00%,and 7.69%,respectively.Staphylo-coccus aureus,hemolytic Staphylococcus,and Staphylococcus epidermidis had resistance rates of 100.00%,90.00%,and 100.00%to penicillin,respectively.The resistance rates of Staphylococcus aureus,hemolytic Staphylococcus,and Staphylococcus epidermidis to quinupristin/dalfopristin were all 0.00%.There were sta-tistically significant differences between the two groups in terms of age,smoking history,diabetes,history of lung disease,surgical method,surgical nature,surgical time,and gastric tube retention(P<0.05).Binary logistic regression analysis showed that smoking history(OR=1.772,p=0.002),diabetes(OR=2.212,P<0.001),history of lung disease(OR=1.950,P=0.001),open surgery(OR=2.522,P<0.001),emer-gency surgery(OR=2.389,P<0.001),surgery time≥2h(OR=2.102,P=0.002),and gastric tube re-tention(OR=1.857,P<0.001)were all risk factors for postoperative respiratory tract infections in patients undergoing gastrointestinal surgery.Conclusion:Postoperative respiratory tract infections in patients undergo-ing gastrointestinal surgery are mainly caused by Gram-negative bacteria.Gram-negative bacteria have high resistance to ampicillin,and Gram-positive bacteria have high resistance to penicillin.The occurrence of post-operative respiratory tract infections is related to multiple risk factors.