阑尾切除术后腹腔感染的病原学

目的了解阑尾炎患者行阑尾切除术后腹腔感染的病原学特点。方法回顾性分析2013年1月—2015年12月某院行阑尾切除术患者的临床病历资料,对腹腔感染患者的病原学特点、治疗及预后情况进行分析。结果共调查阑尾切除术患者431例,38例术后出现腹腔感染,发病率为8.82%。检出病原菌36株,其中革兰阴性菌34株(94.44%),主要为大肠埃希菌(29株,80.55%);革兰阳性菌2株(5.56%),金黄色葡萄球菌和鸟肠球菌各1株。29株大肠埃希菌对临床常用的抗菌药物如阿莫西林、哌拉西林、替卡西林、头孢呋辛、头孢他啶、头孢噻吩的耐药率为72.41%~93.10%,未检出对哌拉西林/他唑巴坦、美罗培南、亚胺培南及阿米卡星耐药的菌株。结论大肠埃希菌是阑尾切除术后腹腔感染最主要的病原菌,且对大多常用抗菌药物的耐药率高,可选用哌拉西林/他唑巴坦、阿米卡星或碳青霉烯类抗生素进行治疗。

Pathogenic characteristics of intra abdominal infection after appendectomy

ObjectiveTo understand the pathogenic characteristics of intra abdominal infection after appendectomy in patients with appendicitis. MethodsClinical data of patients undergoing appendectomy in a hospital from January 2013 to December 2015 were analyzed retrospectively, pathogenic characteristics, treatment, and prognosis of patients with intra abdominal infection were analyzed. ResultsA total of 431 patients undergoing appendectomy were investigated, 38 (8.82%) developed intra abdominal infection. 36 strains of pathogenic bacteria were isolated, 34 (94.44%) of which were gram negative bacteria, mainly Escherichia coli(n=29，80.55%）; 2 (5.56%) strains were gram positive bacteria, 1 of which was Staphylococcus aureus, and the other was Enterococcus avium. The resistance rates of 29 strains of Escherichia coli to commonly used antimicrobial agents (amoxicillin, piperacillin, ticarcillin, cefuroxime, ceftazidime, and cefalotin) were 72.41% 93.10%, none of strains were found to be resistant to piperacillin/tazobactam, meropenem, imipenem, and amikacin. ConclusionEscherichia coli is the most common pathogen causing intra abdominal infection after appendectomy and it has high resistance rates to most commonly used antimicrobial agents, piperacillin/tazobactam, amikacin, and carbapenems are recommended for treating intra abdominal infection after appendectomy.