胸外科住院病人医院感染病原菌、药敏情况及感染相关因素分析

目的分析引起胸外科住院病人医院感染的主要病原菌类型、耐药性及相关因素，为医院感染的诊治、合理使用抗菌药物、有效控制医院感染提供依据。方法对2006年11月1日至2007年10月30日间的胸外科住院病人标本细菌培养及药敏试验、临床资料、易感因素等进行分析。结果1012例病人发生医院感染89例（8．8％），其中术后伤口感染14例（15．7％），肺部感染49例（55．1％），肺部合并伤口感染15例（16．9％），胃肠道感染4例（4．5％），泌尿道感染2例（2.2％），上呼吸道感染5例（5．6％）。病原菌主要为金黄色葡萄球菌、阴沟肠杆菌、大肠杆菌、肺炎克雷伯菌、粪肠球菌、溶血性葡萄球菌等。革兰阳性球菌对万古霉素、链阳霉素、呋喃妥因、庆大霉素等抗菌药物敏感率分别为80．8％、100％、73．1％、53．8％。革兰阴性杆菌对亚胺培南、哌拉西林，他唑巴坦、头孢匹肟、头孢他啶、左氧氟沙星、复方新诺敏等敏感率分别为94．9％、66．7％、64．1％、76．9％、74．4％、38．5％。结论胸外科住院病人的医院感染与病人使用呼吸机、插管、手术大、时间长和长期应用抗生素、激素等因素有关。早诊断和选择敏感抗生素，有益于及时控制病情。

Research on pathogens,drug-resistance and relative factors of nosocomial infection in chest surgery wards

Objective To analyze the main pathogens, drug-resistance and relative factors of nosocomial infection in chest surgery wards, and to provide information for diagnosis and treatment of nosocomial infection, reasonable use of antibacterials and control of nosocomial infection. Methods In a prospective study, bacterium culture, drug sensitivity test, clinical data collection and predisposing factors analysis of patients in chest surgery wards in our hospital were done from November 1, 2006 to October 30, 2007. Results 89 of 1012 patients in chest surgery wards had nosocomial infection, patients with wound infection, pulmonary infection, pulmonary and wound infection, gastrointestinal infection, urinary tract infection and upper respiratory infection accounted for 15.7%, 55.1%, 16.9%, 4.5%, 2.2% and 5.6%, respectively. The main pathogens were Staphylococcus aureus, Staphylococcus haemolyticus, Streptococcus pyogenes, Enterobacter cloacae, Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae. The sensitive rate of vancomycin, streptogramin, teicoplanin, furantoin, rifampin against Gram positive coccus was 100%, 100%, 73.1%, 53.8% respectively. The sensitive rate of imipenem, piperacillin/tazobactam, cefipime, ceftazidime, levofloxacin, ciprofloxacin, trimethoprimsulfamethoxazole against Gram negative bacilli was 100%, 66.7%, 64.1%, 19.7%, 74.1%, 38.5% respectively. Nosocomial infection was related to the factors such as use of breathing machine, cannula, major operation, long-term hospitalization. Conclusions According to analyzing the relative factors, pathogens and drug-resistance of nosocomial infection in chest surgery wards, we provide scientific information for control and prevention of nosocomial infection, and rational application of antibiotic.