下肢动脉急性缺血患者手术部位感染的病原菌分布及耐药性分析

目的分析下肢动脉急性缺血患者手术部位感染(surgical site infections,SSI)的病原菌分布及耐药性,为制订有效的抗感染治疗方案提供研究依据。方法选取2015年1月-2019年1月天津医院的91例下肢动脉急性缺血合并SSI患者作为研究对象,采集其切口分泌物样本,培养分离病原菌并进行药敏试验,对病原菌分布和耐药性进行回顾性分析。结果在71例患者的分泌物样本中检出病原菌,检出率为78.02%,共检出71株病原菌,其中,53株为革兰阳性菌占74.65%,以金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌为主,18株为革兰阴性菌占25.35%,以大肠埃希菌、肺炎克雷伯菌为主。金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌对青霉素G、氨苄西林、磺胺甲噁唑/甲氧苄啶、红霉素、克拉霉素的耐药株数较多,对利福平、庆大霉素的耐药株数较少。大肠埃希菌、肺炎克雷伯菌对氨苄西林、磺胺甲噁唑/甲氧苄啶、头孢唑林、环丙沙星的耐药株数较多,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、丁胺卡那的耐药株数较少。结论革兰阳性菌是导致下肢动脉急性缺血患者SSI的主要病原菌,这些病原菌对多种抗菌药物具有较高的耐药性,临床医生应选取敏感性抗菌药物进行抗感染治疗。

Analysis of distribution and the drug resistance of pathogenic bacteria in surgical infection sites in the patients with acute arterial ischemia of lower extremities

OBJECTIVE To analyze the distribution and the drug resistance of pathogenic bacteria causing surgical site infections(SSI)in the patients with acute arterial ischemia of lower extremities,to provide research basis for the effective anti-infective treatment.METHODS A total of 91 patients with acute arterial embolism complicated with SSI in lower extremities from Jan.of 2015 to Jan.of 2019 in Tianjin Hospital were enrolled as the research subjects.The incision secretion samples were collected,the pathogenic bacteria were cultured and isolated and the drug sensitivity tests were carried out to analyze the distribution and the drug resistance of pathogenic bacteria.RESULTS Seventy-one pathogenic bacteria strains were detected in the the secretion samples of 71 patients,the detection rate was 78.02%.Among them,53 strains were Gram-positive bacteria accounting for 74.65%and Staphylococcus aureus,Staphylococcus epidermidis and Staphylococcus hemolyticus were the main pathogenic bacteria.Eighteen strains were Gram-negative bacteria accounting for 25.35%,and Escherichia coli and Klebsiella pneumoniae were the main pathogenic bacteria.S.aureus,S.epidermidis and S.hemolyticus were more resistant to penicillin G,ampicillin,sulfamethoxazole/trimethoprim,erythromycin and clarithromycin,whereas less resistant to rifampicin and gentamicin.E.coli and K.pneumoniae were more resistant to ampicillin,sulfamethoxazole/trimethoprim,cefazolin and ciprofloxacin,whereas less resistant to cefoperazone/sulbactam,piperacillin/tazobactam and amikacin.CONCLUSION Gram-positive bacteria are the main pathogenic bacteria which caused SSI in patients with acute arterial ischemia of lower extremities.These pathogenic bacteria were highly resistant to a variety of antibiotics.Anti-infective treatment should be considered and sensitive antibiotics should be selected.