摘要
目的:分析医院胃肠外科患者并发术后感染的危险因素与病原学特点,为胃肠外科患者术后感染的防治提供参考。方法:选取2020年8月—2022年3月瑞昌市人民医院收治的465例行手术治疗的胃肠外科患者作为研究对象,根据是否发生术后感染将其分为感染组(n=81)和未感染组(n=384),统计和分析患者并发术后感染的类型、相关危险因素和病原菌分布及其耐药特点。结果:81例并发术后感染患者的感染类型主要为切口感染30例(占37.04%)、肺部感染27例(占33.33%)和腹腔感染17例(占20.99%);回归分析结果显示,胃肠外科患者并发术后感染与年龄、体质量指数、是否合并糖尿病、是否吸烟、手术时间、手术方式、是否保留引流管有关(P<0.05),其中年龄≥60岁、体质量指数≥25、合并糖尿病、吸烟、手术时间≥90 min、开腹手术、保留引流管是患者发生术后感染的独立危险因素(P<0.05);81例并发术后感染患者标本中共检出146株病原菌,其中革兰阴性菌87例(占59.59%,主要为大肠埃希菌和铜绿假单胞菌)、革兰阳性菌44例(占30.14%,主要为金黄色葡萄球菌)和真菌15株(占10.27%);药敏结果显示,大肠埃希菌对头孢替坦、头孢吡肟、哌拉西林-他唑巴坦钠的耐药率较低(<30.00%),铜绿假单胞菌对头孢吡肟、左氧氟沙星的耐药率较低(<20.00%);金黄色葡萄球菌对头孢他啶、替加环素和呋喃妥因的耐药率较低(≤10.00%)。结论:医院胃肠外科患者并发术后感染与年龄、体质量指数、是否合并糖尿病、是否吸烟、手术时间、手术方式、是否保留引流管密切相关,临床应加强对高危患者的管理,以防止感染的发生;此外,患者并发术后感染的病原菌主要有大肠埃希菌、铜绿假单胞菌和金黄色葡萄球菌,这些病原菌存在较强的耐药性,临床在治疗时应尽量根据感染的病原菌特点合理选用抗菌药物,以确保患者治疗的有效性。
Objective:To analyze the risk factors and etiological characteristics of postoperative infection in gastrointestinal surgery patients in the hospital,and provide reference for the prevention and treatment of postoperative infection in gastrointestinal surgery patients.Methods:A total of 465 gastrointestinal surgery patients admitted to the People’s Hospital of Ruichang for surgical treatment from August 2020 to March 2022 were selected as the study subjects.The patients were divided into infection group(n=81)and non-infection group(n=384)according to the occurrence of the postoperative infection.The types of postoperative infection,related risk factors,distribution of pathogenic bacteria and drug resistance characteristics of patients were statistically analyzed.Results:The main types of infection in 81patients with postoperative infection were incision infection in 30 cases(accounting for 37.04%),lung infection in 27cases(accounting for 33.33%)and abdominal infection in 17 cases(accounting for 20.99%).The results of regression analysis showed that postoperative infection in gastrointestinal surgery patients was related to age,body mass index,diabetes,smoking,operation time,operation mode and retention of drainage tube(P<0.05).Among them,age greater than or equal to 60 years,body mass index greater than or equal to 25,diabetes,smoking,operation time longer than or equal to 90min,open surgery and retention of drainage tube were independent risk factors for postoperative infection(P<0.05).A total of 146 strains of pathogenic bacteria were detected from 81 patients with postoperative infection,including 87 strains of Gram-negative bacteria(accounting for 59.59%,mainly Escherichia coli and Pseudomonas aeruginosa),44 strains of Gram-positive bacteria(accounting for 30.14%,mainly Staphylococcus aureus)and 15 strains of fungi(accounting for 10.27%).The results of drug sensitivity showed that the drug resistance rates of Escherichia coli to cefotetan,cefepime and piperacillin-tazobactam sodium were low(less than 30.00%),and the drug resistance rates of Pseudomonas aeruginosa to cefepime and levofloxacin were low(less than 20.00%).The drug resistance rates of Staphylococcus aureus to ceftazidime,tegacycline and furantoin were low(less than or equal to 10.00%).Conclusion:The postoperative infection of gastrointestinal surgery patients in the hospital is closely related to age,body mass index,diabetes,smoking,operation time,operation mode and retention of drainage tube.Clinical management should be enhanced for high-risk patients to prevent infection.In addition,the pathogenic bacteria of patients complicated with postoperative infection mainly include Escherichia coli,Pseudomonas aeruginosa and Staphylococcus aureus,and these pathogenic bacteria have strong drug resistance,so that during clinical treatment,antibacterial drugs should be reasonably selected according to the characteristics of the infective pathogenic bacteria to ensure the effect of treatment.
作者
周利人
ZHOU Li-ren(The People's Hospital of Ruichang,Ruichang Jiangxi 332200,China)
出处
《抗感染药学》
2022年第11期1558-1562,共5页
Anti-infection Pharmacy
关键词
术后感染
危险因素
病原学特点
胃肠外科
postoperative infection
risk factor
etiological characteristics
gastrointestinal surgery
