规范性使用抗菌药物对胸外科术后感染的影响及病原菌耐药性

Effect of normative use of antibiotics on postoperative infection in thoracic surgery department patients and drug resistance of pathogens

目的探讨胸外科手术患者执行规范性使用抗菌药物对术后感染的影响,并分析感染病原菌及主要病原菌耐药性。方法随机选取山东第一医科大学附属人民医院胸外科手术执行规范性使用抗菌药物后6个月住院并接受手术治疗的178例患者为研究组(2023年1月-2023年6月),另选规范执行前1年同期(2022年1月-2022年6月)的178例患者为对照组。比较临床、炎症指标、术后感染发生情况及感染病原菌和主要病原菌耐药性情况。结果与对照组比,研究组抗菌药物使用、发热消退、咳嗽消失、肺部啰音消失及住院时间更短(P<0.05),抗菌药物费用更少(P<0.05)。术后3 d,两组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏C-反应蛋白(hs-CRP)与术前比升高(P<0.05),研究组更低(P<0.05)。与对照组比,研究组术后感染总发生率更低(P<0.05)。两组共发生术后感染30例,共检出菌株36株,其中革兰阴性和阳性菌分别为11和25株。鲍氏不动杆菌、肺炎克雷伯菌对头孢唑林、头孢哌酮、头孢曲松的耐药株数最多,凝固酶阴性葡萄球菌、金黄色葡萄球菌对青霉素、阿莫西林的耐药株数最多。结论对胸外科手术患者执行规范性使用抗菌药物,能够减少患者术后感染发生,不同病原菌的耐药特点各异,需合理选用抗菌药物,以减少耐药现象。

OBJECTIVE To explore the effect of normative use of antibiotics on postoperative infection in the thoracic surgery department patients and observe the distribution and drug resistance of the pathogens causing the infection.METHODS A total of 178 thoracic surgery department patients who were hospitalized and received surgical procedures in Shandong First Medial University Affiliated People′s Hospital after the normative use of antibiotics was carried out for 6 months were assigned as the study group(from Jan.2023 to Jun.2023),and 178 patients for whom the normative use of antibiotics was carried out during the same period 1 year ago(from Jan.2022 to Jun.2022)were chosen as the control group.The clinical indexes,inflammatory indexes,incidence of postoperative infection,distribution and drug resistance of major species of pathogens causing the infection were observed and compared between the two groups.RESULTS The time periods of use of antibiotics,subsidence of fever,disappearance of cough and pulmonary rales as well as length of hospital stay were shorter in the study group than in the control group(P<0.05),the cost of antibiotics of the study group was less than that of the control group(P<0.05).The levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and high-sensitivity C-reactive protein(hs-CRP)of the two groups were higher after the surgery for 3 days than before the surgery(P<0.05),and the levels of above indexes of the study group were lower than those of the control group(P<0.05).The total incidence of postoperative infection of the study group was lower than that of the control group(P<0.05).Totally 30 cases had postoperative infection in the two groups.A total of 36 strains of pathogens were isolated,including 11 strains of gram-negative bacteria and 25 strains of gram-positive bacteria.Acinetobacter baumannii and Klebsiella pneumoniae strains that were resistant to cefazolin,cefoperazone and ceftriaxone were dominant among the isolated pathogens;most of the coagulase-negative Staphylococcus and Staphylococcus aureus strains were resistant to penicillin and amoxicillin.CONCLUSIONS The normative use of antibiotics may reduce the incidence of postoperative infection among the thoracic surgery department patients.It is necessary to reasonably use antibiotics based on the drug resistance of the pathogens so as to reduce the drug resistance.