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目的探讨胆石症患者术后腹腔感染病原菌的分布、药敏情况,并分析引起感染的危险因素。方法选取行手术治疗的胆石症366例,其中发生术后腹腔感染的69例作为研究对象,调查感染病原菌的分布和药敏情况,分析感染的患者因素和医源性因素。结果共分离到病原菌91株,其中革兰阴性菌72株(79.12%)、革兰阳性菌17株(18.68%)、真菌2株(2.20%);较常见的病原菌依次为大肠埃希菌37株(40.66%)、铜绿假单胞菌19株(20.88%)、肺炎克雷伯菌和肠球菌属各9株(9.89%)。术后感染的革兰阴性菌仅对亚胺培南100%敏感,对阿米卡星的敏感率较高;革兰阳性菌对利奈唑胺100%敏感,对万古霉素的敏感率较高。患者的性别、年龄、合并基础疾病、术中损伤性操作、引流管放置及术后抗菌药物使用种类等因素均对胆石症术后腹腔感染的发生率有显著影响(P<0.05或P<0.01)。结论胆石症患者术后腹腔感染的发生与多种因素有关,应采取有针对性的干预措施,以减少术后并发症。
Objective To investigate the distribution and drug sensitivity of pathogenic bacteria in patients with cholelithiasis after operation and to analyze the risk factors of infection. Methods Totally 366 cases of cholelithiasis were treated by surgery. Among them, 69 cases of postoperative intraperitoneal infection were selected as the research object to investigate the distribution and drug susceptibility of the infected pathogens and analyze the infected patients and iatrogenic factors. Results A total of 91 pathogenic bacteria were isolated, of which 72 (79.12%) were Gram-negative bacteria, 17 (18.68%) were Gram-positive bacteria and 2 (2.20%) were fungi. The most common pathogens were Escherichia coli 37 Strain (40.66%), Pseudomonas aeruginosa 19 (20.88%), Klebsiella pneumoniae and Enterococcus 9 strains (9.89%). Gram-negative bacteria were only 100% sensitive to imipenem and sensitive to amikacin. Gram-positive bacteria were 100% sensitive to linezolid and higher susceptibility to vancomycin . The incidence of postoperative abdominal infection in patients with cholelithiasis (P <0.05 or P <0.01) was significantly affected by factors such as sex, age, underlying diseases, intraoperative injury, placement of drainage tube and the type of antibacterials used after operation ). Conclusion The incidence of postoperative abdominal infection in patients with cholelithiasis is related to many factors. Targeted interventions should be taken to reduce the postoperative complications.