摘要
目的手术部位感染(surgical site infections,SSIs)是术后较为难治的并发症之一,SSIs的发生不仅会延长患者的住院时间,增加患者的住院成本,而且会增加患者术后的死亡风险,这在术后多药耐药菌感染中表现的更加突出。本研究旨在探索我院患者术后手术部位耐药菌感染的特点及其耐药率分析。方法选取我院于2008年1月至2013年1月发生SSIs的患者620例进行描述性横断面研究,包括骨科、妇产科以及普外科的患者。通过切口试子采集样本,以及标准微生物检验法对标本微生物进行分析,同时记录患者相关信息。结果 620例SSIs患者的平均年龄为(28.6±12.21)岁,男性148例(23.9%),女性472例(76.1%),其中375例来自妇产科(60.5%);在620例患者中,切口试子在需氧条件下培养阳性者占68.9%(427/620),共分离出细菌600株,其中大肠埃希菌占23.7%(142/600),金黄色葡萄球菌占22.2%(133/600);超过75%的肠杆菌可产生超广谱β-内酰胺酶(extended spectrumβ-lactamase,ESBL),42%的金黄色葡萄球菌为耐甲氧西林的金黄色葡萄球菌(MRSA);多重耐药(multi-drug resistance,MDR)发生率为79.2%(475/600),其中革兰阴性菌占76.9%(373/475),明显高于革兰阳性菌(20.8%,99/475)(χ2=49.219,P<0.0001);阿米卡星和亚胺培南对ESBL阳性的肠杆菌有效,万古霉素对MRSA有效。结论我院SSIs发生率最高的科室为妇产科,致病菌大多为多药耐药菌,亚胺培南和万古霉素仍分别对ESBL阳性的肠杆菌和MRSA有效。
Objective Surgical site infections （SSIs） are difficult to treat and are associated with substantially longer hospital stay, higher treatment cost, morbidity and mortality, particularly when the etiological agent is multidrug-resistant （MDR）. To explore the characteristics and impact of MDR bacterial isolates among patients with SSIs. Methods A descriptive cross sectional study was conducted from Jan 2011 through Jan 2013 involving 314 patients with SSIs in the obstetrics, gynecology, general surgery and orthopedic wards at our hospital. Wound swabs were taken and processed using standard microbiological methods. Demographic characteristics of patients were obtained. Results Of the 620 enrolled patients with SSIs （mean age （28.6±12.21） years）, 490 （75.8%） were female. More than half of the patients were from obstetrics and gynecology （60.5%, 375/620）. Of 620 wound swabs taken, 68.9% （427/620） were culture positive aerobically, yielding 600 bacterial isolates; of which 23.7% （142/600） were Escherichia coli and 22.2% （133/600） were Staphylococcus aureus. More than three quarters of Enterobacteriaceae were found to be extended spectrum beta lactamase （ESBL） producers and 37.5% of S. aureus were methicillin resistant S. aureus （MRSA）. MDR occurred in 79.2% （475/600） of the isolates; these were more among Gram-negative bacteria （76.9%, 373/475） compared to Gram-positive bacteria （20.8%, 99/475）, （χ2=49.219, P〈0.0001）. Amikacin and imepenem for ESBL-producing Enterobacteriacea and vancomycin for MRSA showed excellent performance. Conclusion The incidence of SSIs are higher in obstetrics and gynecology department; most SSIs at our hospital are due to MDR bacteria; amikacin and imepenem for ESBL-producing Enterobacteriacea and vancomycin for MRSA showed excellent performance.
出处
《中国抗生素杂志》
CAS
CSCD
北大核心
2014年第10期769-774,共6页
Chinese Journal of Antibiotics
关键词
手术部位感染
致病菌
耐药率
Antimicrobial resistance
Surgical patients
