摘要
目的调查食管癌术后医院感染患者临床分离菌的耐药性,为食管癌术后感染的治疗提供参考。方法回顾性分析福建省肿瘤医院2007—2011年292例食管癌患者术后发生医院感染、食管癌分期与术后感染的相关性,并进行病原菌鉴定及药敏试验,按照2011年美国临床实验室标准化委员会(CLSI)标准判读结果,采用WHONET5.4软件进行统计。结果食管癌术后医院感染率为17.2%,其中Ⅳ期食管癌术后感染率最高,为29.0%,Ⅰ期术后感染率最低,为7.2%。感染以下呼吸道为主,其次为吻合口瘘、切口、导管相关血流感染等。下呼吸道感染病原菌以革兰阴性杆菌为主,其中铜绿假单胞菌居首位。铜绿假单胞菌与鲍曼不动杆菌对亚胺培南、美罗培南的耐药率均不超过10%,但有逐渐增高趋势。大肠埃希菌对头孢他啶耐药率高于30%,未发现耐碳青霉烯类抗生素的肠杆菌科细菌。金葡菌中MRSA的检出率为33.3%;粪肠球菌对高浓度庆大霉素耐药率为43.8%,未发现耐万古霉素、替考拉宁和利奈唑胺的革兰阳性球菌。结论应及时掌握医院感染病原菌的分布特点及耐药性监测结果,为食管癌患者术后感染预防和治疗提供参考。
Objective To investigate the bacterial resistance of the clinical isolates obtained from esophageal cancer patients with postoperative infections in our hospital,and provide basis for appropriate treatment.Methods A retrospective analysis was conducted for the 292 esophageal cancer patients with postoperative nosocomial infections during the period from2007 to 2011.VITEK Ⅱ was used for pathogen identification and susceptibility testing（MIC method）.The results were interpreted in accordance with the breakpoints released by the Clinical Laboratory Standards Committee（CLSI）in 2011 and analyzed with WHONET5.4 software.Results The incidence of postoperative infection was 17.2%in esophageal cancer patients.The highest incidence of infection（29.0%）was observed in the patients following operation of StageⅣesophageal cancer.The lowest incidence of infection（7.2%）was seen in the patients after operation of Stage I esophageal cancer.The postoperative infections were mainly lower respiratory tract infections,followed by anastomotic leakage,incision,catheter-related bloodstream infections.The pathogens of lower respiratory tract infections were mainly gram-negative bacilli（including Pseudomonas aeruginosa）.Pseudomonas aeruginosa and Acinetobacter baumannii strains were relatively less resistant to imipenem and meropenem（not nore than10%of the isolates were resistant）.But the resistance to carbapenems was increasing in such bacterial isolates.More than 30% of the Escherichia coli isolates were resistant to ceftazidime.No Enterobacteriaceaeisolates were found resistant to carbapenems.The prevalence of MRSCN and MRSA was 66.7%and 33.3%.About 43.8%of the Enterococcus faecalis strains were resistant to high concentration of gentamicin.No isolate of gram positive coccus was found resistant to vancomycin,teicoplanin or linezolid.Conclusions The bacterial pathogens and their susceptibility should be monitored appropriately in order to provide useful information for rational prevention and management of the postoperative infections in patients with esophageal cancer.
出处
《中国感染与化疗杂志》
CAS
北大核心
2013年第4期266-269,共4页
Chinese Journal of Infection and Chemotherapy
关键词
食管癌
术后感染
抗生素耐药性
esophageal cancer
postoperative infection
antibiotic resistance
