摘要
目的分析结肠癌伴急性肠梗阻患者术后切口感染的病原菌分布特点,探讨引起感染的危险因素,为临床预防与治疗感染提供参考。方法回顾性分析2013年6月至2018年6月海宁市中心医院收治的294例结肠癌伴急性肠梗阻手术治疗患者,采集患者切口感染的分泌物样本进行病原菌培养试验,病原菌鉴定采用比色法,药物敏感试验采用比浊法。结果294例结肠癌伴急性肠梗阻手术患者中发生术后切口感染56例,感染率19.05%,共分离出病原菌137株,其中革兰阴性菌86株(62.77%),主要为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌,分别占30.66%、9.49%、6.57%;革兰阳性菌39株(28.47%),主要为金黄色葡萄球菌和表皮葡萄球菌,分别占16.79%、5.84%;真菌12株(8.76%)。革兰阴性菌对阿莫西林、氨苄西林、头孢噻吩的耐药性均较高;革兰阳性菌对阿莫西林、阿奇霉素的耐药率均较高。单因素分析显示患者的年龄、体质量指数、吸烟史和糖尿病、切口类型、手术时间、术后留置导尿管时间以及住院时间是影响其发生术后切口感染的危险因素(P<0.05)。多因素logistic分析显示,年龄≥60岁、有吸烟史、合并糖尿病、Ⅲ类切口、手术时间≥120 min、术后留置导尿管≥3 d、住院时间≥10 d是患者术后出现感染的危险因素(P<0.05)。结论多种因素均可影响结肠癌伴急性肠梗阻患者的术后切口感染,应对患者术后感染的风险进行充分评估,根据危险因素进行针对性预防,合理应用抗菌药物以减少伤口感染的发生率,对伤口感染者治疗时应根据病原菌种类及药敏结果针对性地应用抗菌药物,以期减少耐药菌的产生。
Objective To describe the distribution characteristics of pathogenic bacteria of postoperative incision infections in colon cancer patients complicated with acute intestinal obstruction,and to analyze its related the risk factors.Methods From June 2013 to June 2018,a total of 294 patients with colon cancer and acute intestinal obstruction who underwent surgery in Haining Central Hospital were enrolled.Clinical data of patients were acquired.Bacterial cultures were performed on infected incision secretion samples and bacteria were identified by colorimetric method.Turbidimetric method was used for drug sensitivity test.Results 56 out of 294 cases developed postoperative incision infections,with the infection rate of 19.05%.A total of 137 strains of pathogenic bacteria were isolated,86 strains(62.77%)were gram-negative bacteria,escherichia coli,pseudomonas aeruginosa and klebsiella pneumonia were predominant,accounting for 30.66%,9.49%and 6.57%,respectively.39 strains(28.47%)were gram-positive bacteria,staphylococcus aureus and staphylococcus epidermidis were predominant,accounting for 16.79%and 5.84%,respectively.12 strains(8.76%)were fungi.Gram-negative bacteria were highly resistant to amoxicillin,ampicillin and cephalothiophene,while gram-positive bacteria were highly resistant to amoxicillin and azithromycin.Univariate logistic regression analysis showed that age,body mass index,smoking history and diabetes,incision type,operation time,postoperative indwelling catheter time and length of hospital stay were risk factors for postoperative incision infection(P<0.05).Multivariate logistic regression analysis showed that age of≥60 years,history of smoking,diabetes mellitus,typeⅢincision,operation duration of≥120 min,postoperative urethral catheter indwelling of≥3 days,length of hospital stay for≥10 days were risk factors for patients with postoperative infections(P<0.05).Conclusions Multiple factors may affect postoperative incision infection in patients with colon cancer and acute intestinal obstruction.The risk of postoperative infection should be fully assessed,targeted intervention should be proposed and drug susceptibility test should be performed to reduce the chances of incision infection and increase the efficacy of antibiotic treatment.
作者
翁晓晖
陶亮
贺强
朱晓燕
周伟光
谢志杰
WENG Xiao-hui;TAO Liang;HE Qiang;ZHU Xiao-yan;ZHOU Wei-guang;XIE Zhi-jie(Department of General Surgery,Haining Central Hospital,Haining,Zhejiang 314408,China;不详)
出处
《中国预防医学杂志》
CAS
CSCD
2020年第4期388-392,共5页
Chinese Preventive Medicine
基金
浙江省医药卫生科技计划基金资助项目(2016ZHB026)
关键词
结肠癌
肠梗阻
切口感染
病原菌
危险因素
Colon cancer
Intestinal obstruction
Postoperative incision infection
Pathogenic bacteria
Risk factor
