手术切口感染病原菌分析及管理策略

目的探讨手术切口感染的病原菌及药物敏感性，制定相应的管理策略，为控制医院感染提供参考。方法回顾性分析某院4335例外科手术患者切口感染情况，收集伤口分泌物进行细菌培养及鉴定，对培养细菌进行药物敏感性分析，并制定相应的手术室管理策略。结果4335例外科手术患者发生切口感染189例次检出致病菌162株，其中G＋杆菌占79．0％，其中主要为大肠埃希菌占29．6％、肺炎克雷伯杆菌占22．2％、铜绿假单胞菌占19．8％；G＋球菌占15．4％；真菌占5．56％。药敏分析发现G＋菌对亚胺培南最为敏感，而对青霉素、庆大霉素、头孢氨苄、克林霉素等的耐药率均超过50％。G＋菌对亚胺培南、万古霉素敏感性强，对其他抗生素均有较高的耐药性。结论手术切口感染病原菌多以G-菌为主，并且具有较高的耐药性，必须采取合理的管理策略，预防感染发生。

Analysis of bacteriology and management strategy in operative incision infection

Objective To explore the bacteriology and drug sensitivity of operative incision infection and to construct corresponding management strategy in order to provide references for controlling hospital infection. Methods The operative incision infections of 4 335 patients who underwent surgery were analyzed retrospectively. Incision secretion was collected, bacteria culture was performed and pathogen identification as well as drug sensitivity analysis was done. Meanwhile, corresponding management strategy was constructed. Results Of the 4 335 patients who underwent surgery, 189 patients had operative incision infection with a total of 162 strains of bacteria. The pathogenic bacteria were majored in G- bacillus （79%） including colibacillus （29.6%）, klebsiella pneumoniae（22.2% ） and pseudomonas aeruginosa （19.8%）. G＋ coccobacteria accounted for 15.4% and fungus accounted for 5.56%. According to the drug sensitive test, Gbacillus was most sensitive to imipenem but its drug resistance to penicillin, cidomycin, cefalexin, clindamycin ect was more than 50%. G ＋ coccobaeterium was sensitive to imipenem and vancocin but resistant to other antibiotics. Conclusion Gbacillus, having high rate of drug resistance, is the main pathogenic bacteria of operative incision infection. Reasonable management strategy must be adopted to prevent the infection.