胆囊切除术后手术部位感染病原菌的分布与耐药性分析

发布时间：2018-05-15 02:41

本文选题：胆囊切除术 + 医院感染　；参考：《中华医院感染学杂志》2017年18期

【摘要】：目的探讨胆囊切除患者术后医院感染病原菌分布及其耐药性。方法选取2014年3月-2017年3月肝胆外科1815例行胆囊切除术患者为研究对象,其中行开腹胆囊切除术712例,行腹腔镜胆囊切除术1103例,分析不同手术方式术后医院感染情况和术后不同感染部位病原菌分布及其耐药性。结果 1815例胆囊切除术患者术后发生医院感染109例,感染率为6.0%,其中开腹胆囊切除术患者术后感染47例,感染率为8.7%,显著高于腹腔镜胆囊切除术患者(χ~2=15.16,P0.01);109例术后感染患者中浅表手术切口感染率明显高于深部手术切口感染及脏器或腔隙感染率;感染患者病原菌送检标本共分离出109株病原菌,其中革兰阳性菌41株占37.6%,革兰阴性菌57株占52.3%,其他菌11株占10.1%;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁的耐药率较低,革兰阴性菌对亚胺培南、美罗培南、阿米卡星、妥布霉素的耐药率较低。结论为有效降低胆囊切除术后医院感染率及细菌耐药率,术前应及时采取预防措施,术中应严格无菌操作,术后应根据药敏试验结果合理选用抗菌药物。
[Abstract]:Objective to investigate the distribution and drug resistance of nosocomial infection pathogens after cholecystectomy. Methods 1815 patients undergoing cholecystectomy in hepatobiliary surgery from March 2014 to March 2017 were selected as subjects. 712 patients underwent open cholecystectomy and 1103 patients underwent laparoscopic cholecystectomy. To analyze the nosocomial infection and the distribution and drug resistance of pathogens in different postoperative infection sites. Results Nosocomial infection occurred in 1815 patients after cholecystectomy, and the infection rate was 6.0%. Among them, 47 cases had postoperative infection after open cholecystectomy. The infection rate of superficial incision was significantly higher than that of deep incision infection and visceral or lacunar infection in 109 patients with postoperative infection. A total of 109 pathogenic bacteria were isolated from the infected patients, of which 41 were Gram-positive bacteria (37.6%), 57 Gram-negative bacteria (52.3B) and 11 others (10.1cm). The resistance rate of Gram-positive bacteria to vancomycin, linazolamide and teicolanine was low, and the resistance rate of Gram-positive bacteria to vancomycin, linazolamine and teicolanine was low. The resistance rate of Gram-negative bacteria to imipenem, meropenem, amikacin and tobramycin was low. Conclusion in order to effectively reduce the nosocomial infection rate and bacterial drug resistance rate after cholecystectomy, preventive measures should be taken before operation, strict aseptic operation should be performed during operation, and antibiotics should be reasonably selected according to the results of drug sensitivity test after operation.
【作者单位】：宜宾市第三人民医院药剂科;宜宾市第三人民医院肝胆外科;宜宾市第一人民医院药剂科;
【基金】：宜宾市重点科技计划基金资助项目(2014YZY003)
【分类号】：R657.4

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