食管癌术后吻合口瘘感染患者病原菌分布及其耐药性

目的了解食管癌术后吻合口瘘感染患者病原菌分布及其耐药情况,为临床诊疗提供依据。方法回顾性分析2012年1月—2015年12月某院收治的食管癌术后吻合口瘘患者的微生物培养结果及药敏试验结果。结果 4年间行食管癌根治术患者1 986例,术后出现吻合口瘘148例,104例微生物培养阳性,阳性率为70.27%。共分离病原菌197株,其中胸内吻合口瘘52株(占26.40%),颈部吻合口瘘145株(占73.60%);革兰阴性菌127株(占64.47%),以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌为主,革兰阳性菌62株(占31.47%),以金黄色葡萄球菌、肠球菌属、草绿色链球菌为主,真菌8株(占4.06%);混合菌感染者49例(47.12%)。革兰阴性菌对亚胺培南耐药率在17.86%~47.62%,对多粘菌素B耐药率为0,其中铜绿假单胞菌对其他抗菌药物耐药率均50%,肺炎克雷伯菌对哌拉西林、氨曲南耐药率均70%,鲍曼不动杆菌对大部分抗菌药物耐药率50.00%;革兰阳性菌对克林霉素、四环素耐药率均50.00%,对利奈唑胺、万古霉素、替考拉宁耐药率均为0,其中金黄色葡糖球菌对青霉素、苯唑西林、环丙沙星耐药率均60%,肠球菌属对奎奴普丁/达福普汀耐药率为100.00%。结论食管癌术后吻合口瘘合并感染影响患者的预后,定期对病原菌分布及其耐药性进行监测,为最初经验性治疗提供依据,有利于早期治疗及合理应用抗菌药物。

Distribution and drug resistance of pathogens from patients with anastomotic fistula infection after esophageal cancer surgery

ObjectiveTo understand the distribution and drug resistance of pathogens from patients with anastomotic fistula infection after esophageal cancer surgery, and provide basis for clinical diagnosis and treatment. MethodsPatients were admitted to a hospital due to anastomotic fistula after esophageal cancer surgery between January 2012 and December 2015, microbial culture and antimicrobial susceptibility testing results of patients were retrospectively analyzed. Results1 986 patients underwent radical resection of esophageal cancer within 4 years, 148 of whom developed anastomotic fistula, 104 (70.27%) were with positive microbial culture. A total of 197 pathogenic strains were isolated, 52（26.40%）and 145 （73.60%）strains were isolated from intrathoracic anastomotic fistula and cervical anastomotic fistula respectively；127 (64.47%）strains were gram negative bacteria, the major were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii, 62(31.47%) strains were gram positive bacteria, the major were Staphylococcus aureus, Enterococcus spp., and Streptococcus viridans, 8 strains (4.06%) were fungi. 49（47.12%） cases were with mixed pathogenic infection. The resistance rates of gram negative bacteria to imipenem were 17.86% 47.62%, to polymyxin B was 0, resistance rates of Pseudomonas aeruginosa to other antimicrobial agents were all<50%, Klebsiella pneumoniae to piperacillin and aztreonam were both>70%, Acinetobacter baumannii to most antimicrobial agents were all>50.00%; resistance rates of gram positive bacteria to clindamycin and tetracycline were both>50.00%, to linezolid, vancomycin, and teicoplanin were all 0, resistance rates of Staphylococcus aureus to penicillin, oxacillin, and ciprofloxacin were all>60%，resistance rate of Enterococcus spp. to quinupristin/dalfopristin was 100.00%. ConclusionPostoperative anastomotic fistula combined with infection can affect the prognosis of patients after esophageal cancer surgery, regular monitoring on distribution and drug resistance of pathogens can provide the basis for initial empirical treatment, and is conducive to the early treatment and rational use of antimicrobial agents.