摘要
目的了解肛肠疾病术后感染的病原菌分布和耐药性特征,为术后细菌性感染的诊断与治疗提供预防措施。方法收集2016—2018年肛肠科手术患者的临床资料,分析肛肠疾病术后感染的病原菌分布特征和耐药性;应用SPSS18.0软件进行数据分析。结果在2714例肛肠疾病手术患者中,186例发生术后感染(6.85%),其中痔疮92例、肛周脓肿57例、肛裂18例、肛瘘15例、肛乳头肥大3例和直肠息肉1例。从切口部位组织或分泌物中分离194株病原菌,其中革兰阴性菌121株(62.37%),革兰阳性菌68株(35.05%)和真菌5株(2.58%)。不同肛肠疾病术后感染的病原菌种类和分离率存在较大差异。大肠埃希菌等革兰阴性菌对阿米卡星敏感,对头孢吡肟和氨苄西林/舒巴坦较敏感,对左氧氟沙星耐药率较低,对第一、二代头孢类菌素和第二代喹诺酮类抗菌药物均存在较高耐药性,但未发现亚胺培南耐药株。耐3种以上抗菌药物的革兰阴性菌47株,占革兰阴性菌38.8%。表皮葡萄球菌和金黄色葡萄球菌对利福平敏感;粪肠球菌对利福平和利奈唑胺较敏感;表皮葡萄球菌等革兰阳性菌对氨基糖苷类、喹诺酮类和青霉素类抗菌药物均有较高的耐药性,但未发现万古霉素耐药株以及利奈唑胺耐药的表皮葡萄球菌和金黄色葡萄球菌。耐3种以上抗菌药物的革兰阳性菌22株,占革兰阳性菌32.4%。结论肛肠疾病术后感染的病原菌主要为革兰阴性菌,临床应根据病原菌分布特征和耐药性分析,采取积极有效的针对性干预措施,降低肛肠疾病术后感染率和耐药菌的产生。
Objective To investigate the distribution and drug resistance of pathogenic bacteria in postoperative infections of anorectal surgery,and to provide preventive measures for the diagnosis and treatment of bacterial infections.Methods Clinical data of patients undergoing anorectal surgery were collected in our hospital from 2016 to 2018,and then the distribution characteristics and drug resistance of pathogenic bacteria after anorectal surgery were analyzed using SPSS 18.0 software.Results Of the 2,714 patients,186 cases(6.85%)showed postoperative infections after anorectal surgery,including 92 hemorrhoids,57 perianal abscess,18 anal fistula,15 anal fistula,3 anal papilla hypertrophy,and 1 rectal polyp.There were 194 strains of pathogenic bacteria isolated from the site of incision or secretions around the incision,including 121(62.37%)Gram-negative bacteria,68(35.05%)Grampositive bacteria,and 5(2.58%)fungi.Notably,there were great differences in types and separation rate of bacteria in patients undergoing different kinds of anorectal surgery.Gram-negative bacteria such as Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis were more sensitive to amikacin,cefepime and ampicillin/sulbactam,and they showed low resistance rate to levofloxacin and high resistance rate to the first,second generation cephalosporins and second generation quinolones,yet no resistant strain to imipenem was detected.Among Gram-negative bacteria,there were 47 strains(38.8%)that were resistant to more than three kinds of antibacterial drugs.Moreover,Staphylococcus epidermidis and Staphylococcus aureus were more sensitive to rifampicin,and Enterococcus faecalis was sensitive to rifampicin and linezolid.Additionally,Gram-positive bacteria such as Staphylococcus epidermidis showed high resistance to aminoglycosides,quinolones and penicillins,yet no resistant strain to vancomycin,as well as linezolid resistant Staphylococcus epidermidis and Staphylococcus aureus,were detected.Among Gram-positive bacteria,there were 22 strains(32.4%)that w
作者
陈静芸
陈志成
仲铃琳
程科萍
刘倩
Chen Jing-yun;Chen Zhi-cheng;Zhong Ling-lin;Cheng Ke-ping;Liu Qian(Anorectal Department,Zhongda Hospital Affiliated to Southeast University,Nanjing 210009;Department of Hospital Infection Management,Southeast University,Nanjing 210009)
出处
《中国抗生素杂志》
CAS
CSCD
2019年第10期1220-1224,共5页
Chinese Journal of Antibiotics
基金
江苏省中医药局(No.YB2017099)
关键词
肛肠手术
术后感染
病原菌
耐药性
Anorectal surgery
Post-operative infection
Pathogens
Drug resistance
