| 罗逸潜,于润泽,王媛媛,孙燕飞,马 勇.胰十二指肠切除患者术后腹腔感染的危险因素和病原学特征及药敏试验分析[J].,2019,19(20):3875-3879 |
| 胰十二指肠切除患者术后腹腔感染的危险因素和病原学特征及药敏试验分析 |
| Risk Factors, Etiological Characteristics and Drug Sensitivity Test Analysis of Postoperative Abdominal Infection in Patients with Pancreaticoduodenectomy |
| 投稿时间：2019-04-08 修订日期：2019-04-30 |
| DOI：10.13241/j.cnki.pmb.2019.20.017 |
| 中文关键词: 胰十二指肠切除术 腹腔感染 危险因素 病原学特征 药敏试验 |
| 英文关键词: Pancreaticoduodenectomy Abdominal infection Risk factors Pathogenic characteristics Drug sensitivity test |
| 基金项目:辽宁省科学技术基金资助项目（2015030211）；大连市医学科学研究计划项目（1712061） |
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| 中文摘要: |
| 摘要 目的：探讨胰十二指肠切除患者术后腹腔感染的危险因素，并对其进行病原学特征及药敏试验分析。方法：回顾性分析2016年1月到2018年12月期间在中国人民解放军联勤保障部队第967医院接受胰十二指肠切除术治疗的60例患者的临床资料，分析术后腹腔感染的危险因素。根据细菌培养结果和药敏试验情况对术后腹腔感染患者的病原菌分布情况及其耐药性进行分析。结果：单因素分析显示术中输血量、肺部感染、胆瘘、胰瘘均与腹腔感染的发生有关（P<0.05）。多因素Logistic回归分析显示，术中输血量≥1000 mL、肺部感染、胆瘘、胰瘘均是胰十二指肠切除患者术后发生腹腔感染的危险因素（P<0.05）。20例术后腹腔感染患者的腹腔引流液中共培养出54株菌株，其中革兰阳性菌23株（42.59%）、革兰阴性菌28株（51.85%）、真菌3株（5.56%），主要革兰阳性菌（粪肠球菌、屎肠球菌、表皮葡萄球菌）对环丙沙星、红霉素敏感率低，均低于17.00%，对利奈唑胺、万古霉素敏感率高，均为100.00%，主要革兰阴性菌（大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌）对头孢他啶、头孢唑林和哌拉西林的敏感率较低，均低于或等于25.00%，对庆大霉素、亚胺培南的敏感率较高，均高于或等于80.00%。结论：术中输血量过多以及发生了肺部感染、胆瘘、胰瘘均是胰十二指肠切除患者术后发生腹腔感染的危险因素，临床上应根据药敏试验结果针对性地使用抗菌药物。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the risk factors of abdominal infection after pancreaticoduodenectomy and analyze its etiological characteristics and drug sensitivity test. Methods: The clinical data of 60 cases undergoing pancreaticoduodenectomy in the 967th Hospital of the PLA Joint Logistics Support Force from January 2016 to December 2018 were retrospectively analyzed, the risk factors for postoperative abdominal infection were analyzed. The distribution and drug resistance of pathogenic bacteria in patients with postoperative abdominal infection were analyzed according to the results of bacterial culture and drug sensitivity test. Results: Univariate analysis showed that intraoperative blood transfusion, pulmonary infection, biliary fistula and pancreatic fistula were all related to the occurrence of abdominal infection (P<0.05). Multivariate Logistic regression analysis showed that intraoperative blood transfusion greater than 1000 mL, pulmonary infection, biliary fistula and pancreatic fistula were risk factors for abdominal infection after pancreaticoduodenectomy (P<0.05). A total of 54 strains were cultured in the peritoneal drainage fluid of 20 patients with postoperative abdominal infection. Among them, 23 strains (42.59%), 28 strains (51.85%) and 3 strains (5.56%) were Gram-positive bacteria. The main Gram-positive bacteria (Enterococcus faecalis, Staphylococcus epidermidis) were less sensitive to ciprofloxacin and erythromycin, all were below 17.00%, the sensitivity rates to linezolid and vancomycin were 100.00%. The main Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae) less sensitive to ceftazidime, cefazolin and piperacillin, all were below or equal to 25.00%, the susceptibility rates to gentamicin and imipenem were higher, all were higher or equal to 80.00%. Conclusion: Excessive blood transfusion during operation and occurrence of pulmonary infection, biliary fistula and pancreatic fistula are risk factors for abdominal infection after pancreaticoduodenectomy. Antibiotics should be use targetedly in clinic according to the results of drug sensitivity test. |
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