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目的探讨腹部手术切口感染的病原菌分布及耐药性,为临床选择合适的抗菌药物控制感染提供参考依据。方法回顾分析2011年-2015年本院普外科6 289例患者术后切口感染率、病原菌分布及药敏试验。结果 6 289例腹部手术患者发生切口感染263例,感染率为4.18%。感染率总体呈逐年下降趋势,其中后2年切口感染率明显低于前3年,差异有统计学意义(P<0.05)。分离病原菌227株,其中革兰阴性菌137株,革兰阳性菌74株,真菌16株。革兰阴性菌主要为铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌,革兰阳性菌主要为葡萄球菌属和肠球菌属。革兰阴性菌对亚胺培南敏感,对加酶抑制剂复合抗菌药物耐药率均低于15%,革兰阳性菌对万古毒素和替考拉宁全部敏感,对亚胺培南较敏感,耐药率均<10%。结论外科手术切口感染的病原菌多为多药耐药菌,临床应重视手术切口感染病原菌的监测,根据病原菌分布和耐药率的变化特点调整治疗方案,减少手术切口感染的发生率和耐药菌的产生。
Objective To investigate the distribution and drug resistance of pathogenic bacteria in incisional wound infection in abdomen, and to provide a reference for selecting suitable antibacterials for clinical infection control. Methods The postoperative incision infection rate, pathogen distribution and drug sensitivity test of 6 289 patients in our department from 2011 to 2015 were retrospectively analyzed. Results 6 289 cases of incision infection in patients with abdominal surgery occurred in 263 cases, the infection rate was 4.18%. The overall infection rate showed a decreasing trend year by year, among which incision infection rate in the latter two years was significantly lower than that in the previous three years (P <0.05). 227 strains of pathogens were isolated, of which 137 were Gram-negative bacteria, 74 were Gram-positive bacteria and 16 were fungi. Gram-negative bacteria are mainly Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae, Gram-positive bacteria mainly Staphylococcus and Enterococcus. Gram-negative bacteria were sensitive to imipenem, with less than 15% of antibiotics combined with enzyme inhibitors, Gram-positive bacteria were all sensitive to everlasting toxin and teicoplanin, more sensitive to imipenem , The resistance rate was <10%. Conclusions Most of the pathogenic bacteria infected by surgical incision are multidrug-resistant bacteria. Clinicians should pay more attention to the surveillance of pathogenic bacteria in incisional wound infection, adjust the treatment plan according to the distribution of pathogenic bacteria and the change of drug resistance rate, reduce the incidence of surgical incision infection and drug- The production.