98例下肢静脉曲张患者术后院内感染病原菌的分布及其耐药性研究

目的:探究下肢静脉曲张患者术后院内感染病原菌的分布及其对抗菌药物的耐药性。方法:采用回顾性分析法,抽取2013年2月-2018年2月间在医院接受治疗的下肢静脉曲张术后院内感染患者98例临床资料,分析患者术后院内感染病原菌培养与分离情况,以及药敏试验结果对不同抗菌药物耐药程度的影响。结果:98例下肢静脉曲张术后院内感染患者标本中,检出84株病原菌,其中革兰阴性菌51株(占60.71%)、革兰阳性菌30株(占35.71%)和真菌3株(占3.58%),经组间数据比较其差异有统计学意义(P<0.05);革兰阴性菌以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为主,革兰阳性菌以表皮葡萄球菌、金黄色葡萄球菌为主;铜绿假单胞菌对氨苄西林、头孢唑林、头孢曲松的耐药性较高;大肠埃希菌对氨苄西林、头孢唑林、头孢曲松、氨曲南的耐药性较高;肺炎克雷伯菌对氨苄西林、头孢曲松、阿米卡星的耐药性较高;表皮葡萄球菌对头孢唑林、青霉素G、克林霉素的耐药性较高;金黄色葡萄球菌对环丙沙星、青霉素G、克林霉素的耐药性较高。结论:下肢静脉曲张患者手术后院内感染病原菌以革兰阴性菌为主,且革兰阴性菌和革兰阳性菌对氨苄西林、头孢唑林、头孢曲松、氨曲南、克林霉素、青霉素G等抗菌药物的耐药性较高;临床治疗应依据药敏试验结果选用抗菌药物治疗。

Study on Pathogens Distribution and Resistance of Nosocomial Infection in 98 Patients with Postoperative Varicose Veins of Lower Extremities

Objective: To study the pathogens distribution and drug resistance of nosocomial infection in patients with varicose veins of lower extremities(VVLE) after operation. Methods: The clinical data of 98 patients with postoperative nosocomial infection of VVLE who were treated in our hospital from February 2013 to February 2018 were analyzed retrospectively. The status of pathogen culture and isolation of postoperative nosocomial infection, as well as the influence of drug susceptibility test results on the degree of different antibiotic resistance were analyzed. Results: A total of 84 strains of pathogenic bacteria were detected in 98 patients with postoperative infection of VVLE. Among them,51 strains of Gram-negative bacteria accounted for 60.71%, 30 strains of Gram-positive bacteria accounted for 35.71% and3 fungal strains accounted for 3.58%, with statistical difference(P<0.05). The majority of Gram-negative bacteria were Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and the majority of Gram-positive bacteria were Staphylococcus epidermidis and Staphylococcus aureus. The resistance of Pseudomonas aeruginosa to ampicillin, cefazolin and ceftriaxone was high;that of Escherichia coli to ampicillin, cefazolin, ceftriaxone and aztreonam was high;that of Klebsiella pneumoniae to ampicillin,ceftriaxone and amikacin was high. Staphylococcus epidermidis was highly resistant to cefazolin,penicillin G and clindamycin,while Staphylococcus aureus was highly resistant to ciprofloxacin, penicillin G and clindamycin. Conclusion: Gram-negative bacteria were the main pathogens of nosocomial infection in patients with VVLE, and Gram-negative bacteria and Gram-positive bacteria were highly resistant to ampicillin,cefazolin, ceftriaxone, aztreonam, clindamycin, penicillin G and other antibiotics. The clinical treatment should be based on the results of drug sensitivity test.