摘要
目的探讨妇科肿瘤术后腹腔感染的病原菌分布情况及其耐药性。方法回顾性分析2017年3月至2019年2月在广西医科大学附属南宁市妇幼保健院接受手术治疗的妇科恶性肿瘤患者117例作为研究对象,于腹腔感染确诊当日应用抗菌药物之前采集患者的腹腔引流液样本送至实验室做细菌培养及药敏试验。结果117例妇科肿瘤术后腹腔感染患者共检测出病原菌188株,革兰氏阴性菌114株,占60.64%,其中以大肠埃希菌为主,占20.21%,肺炎克雷伯菌次之;革兰氏阳性菌58株,占30.85%,其中以表皮葡萄球菌为主,占12.23%;真菌16株,占8.51%。大肠埃希菌对头孢曲松、头孢噻肟、复方新诺明、环丙沙星的耐药性较高,依次为63.16%、60.53%、60.52%、57.89%;对替加环素的耐药性为0,对阿卡米星、厄他培南、亚胺培南、哌拉西林/他唑巴坦的耐药性均为2.63%。肺炎克雷伯菌对阿莫西林、头孢曲松、头孢噻肟的耐药性较高,依次为76.0%、44.0%、44.0%;对替加环素耐药性较低,为4.0%。铜绿假单胞菌对头孢曲松、复方新诺明、阿莫西林的耐药性分别为85.71%、85.71%、71.43%,对阿卡米星的耐药性为0。金黄色葡萄球菌对复方新诺明、青霉素的耐药性较高,分别为95.0%、90.0%,对利奈唑胺耐药性为0。表皮葡萄球菌对四环素和青霉素的耐药性较高,均为73.91%;对氨苄西林和利奈唑胺的耐药性为0。结论妇科恶性肿瘤术后腹腔感染病原菌种类多,以大肠埃希菌、肺炎克雷伯菌等革兰氏阴性菌为主,少数金黄色葡萄球菌、表皮葡萄球菌等革兰氏阳性菌,总体病原菌耐药形势不容乐观。妇科恶性肿瘤术后腹腔感染的治疗方案需建立在对感染情况进行全面评估的基础上,临床药师协助医师做好病情评估,为患者选择科学合理的用药方案,并监测不良反应,在治疗过程中根据病原学证据及不良反应随时调整治疗方案。
Objective To explore the distribution of pathogenic bacteria in abdominal cavity infection and their drug resistance after gynecological tumor surgery.Methods A retrospective analysis of 117 patients with gynecological malignancies who underwent surgical treatment at The Affiliated Nanning Maternal and Child Health Hospital of Guangxi Medical University from March 2017 to February 2019 was used as the research object.On the day of the diagnosis of abnormal infection,samples of the patient’s abnormal drainage fluid were collected and sent to the lab for bacterial culture and drug susceptibility festing before applying antibiotics.Results A total of 188 pathogenic bacteria were detected in 117 patients with abdominal cavity infection after gynecological tumor surgery,114 of Gram-negative bacteria,accounting for 60.64%,of which Escherichia coli was the main one,accounting for 20.21%,followed by Klebsiella pneumoniae;58 strains of Gram-positive bacteria,accounting for 30.85%,of which Staphylococcus epidermidis was the main strain,accounting for 12.23%;16 fungi,accounting for 8.51%.Escherichia coli had higher resistance to ceftriaxone,cefotaxime,compound trimethoprim and ciprofloxacin,followed by 63.16%,60.53%,60.52%,57.89%;resistance to tigecycline is 0,and the drug resistance of arkamicin,ertapenem,imipenem,piperacillin/tazobactam was 2.63%.Klebsiella pneumoniae had higher resistance to amoxicillin,ceftriaxone,and cefotaxime,followed by 76.0%,44.0%and 44.0%;resistance to tigecycline was lower,4.0%.The resistance of pseudomonas aeruginosa to ceftriaxone,compound trimethoprim and amoxicillin was 85.71%,85.71%,and 71.43%,respectively,and the resistance to acamicin was 0.Staphylococcus aureus has high resistance to compound trimethoprim and penicillin,95.0%and 90.0%,respectively,and resistance to linezolid is 0.Staphylococcus epidermidis has high resistance to tetracycline and penicillin,both 73.91%;resistance to ampicillin and linezolid is 0.Conclusion There are many types of pathogenic bacteria in abdominal cavity infection after gynecological malignant tumors,mainly Gram-negative bacteria such as escherichia coli and klebsiella pneumoniae,a few Gram-positive bacteria such as staphylococcus aureus and staphylococcus epidermidis,the overall pathogenic bacteria resistance situation is not optimistic.The treatment plan for abdominal infection after gynecological malignancy needs to be based on a comprehensive evaluation of the infection.The clinical pharmacist assists the physician in the evaluation of the condition,selects the scientific and reasonable medication plan for the patient,and monitors adverse reactions.During the treatment process,according to pathogenic evidence and adverse reactions,the treatment plan is adjusted at any time.
作者
叶菡
梁思龙
黄薏霏
YE Han;LiANG Silong;HUANG Yifei(Department of Pharmacy,The Affiliated Nanning Maternal and Child Health Hospital of Guangxi Medical University,Nanning Guangxi 530001,P.R.China)
出处
《中国计划生育和妇产科》
2021年第4期77-80,94,共5页
Chinese Journal of Family Planning & Gynecotokology
关键词
妇科肿瘤
术后
腹腔感染
病原菌
药学监护
gynecological tumors
postoperative
abdominal cavity infection
pathogenic bacteria
pharmaceutical care
