阑尾切除术后腹腔感染的病原学

摘要

Objective To understand the pathogenic characteristics of intra-abdominal infection after appendecto-my in patients with appendicitis.Methods Clinical data of patients undergoing appendectomy in a hospital from January 2013 to December 2015 were analyzed retrospectively,pathogenic characteristics,treatment,and prognosis of patients with intra-abdominal infection were analyzed.Results A total of 431 patients undergoing appendectomy were investigated,38 (8.82%)developed intra-abdominal infection.36 strains of pathogenic bacteria were isolated, 34 (94.44%)of which were gram-negative bacteria,mainly Escherichiacoli(n=29,80.55%);2 (5.56%)strains were gram-positive bacteria,1 of which was Staphylococcusaureus,and the other was Enterococcusavium.The re-sistance rates of 29 strains of Escherichia coli to commonly used antimicrobial agents (amoxicillin,piperacillin,ti-carcillin,cefuroxime,ceftazidime,and cefalotin)were 72.41%-93.10%,none of strains were found to be resistant to piperacillin/tazobactam,meropenem,imipenem,and amikacin.Conclusion Escherichiacoli is the most common pathogen causing intra-abdominal infection after appendectomy and it has high resistance rates to most commonly used antimicrobial agents,piperacillin/tazobactam,amikacin,and carbapenems are recommended for treating intra-abdominal infection after appendectomy.%目的 了解阑尾炎患者行阑尾切除术后腹腔感染的病原学特点.方法 回顾性分析2013年1月—2015年12月某院行阑尾切除术患者的临床病历资料,对腹腔感染患者的病原学特点、治疗及预后情况进行分析.结果 共调查阑尾切除术患者431例,38例术后出现腹腔感染,发病率为8.82%.检出病原菌36株,其中革兰阴性菌34株(94.44%),主要为大肠埃希菌(29株,80.55%);革兰阳性菌2株(5.56%),金黄色葡萄球菌和鸟肠球菌各1株.29株大肠埃希菌对临床常用的抗菌药物如阿莫西林、哌拉西林、替卡西林、头孢呋辛、头孢他啶、头孢噻吩的耐药率为72.41%~93.10%,未检出对哌拉西林/他唑巴坦、美罗培南、亚胺培南及阿米卡星耐药的菌株.结论 大肠埃希菌是阑尾切除术后腹腔感染最主要的病原菌,且对大多常用抗菌药物的耐药率高,可选用哌拉西林/他唑巴坦、阿米卡星或碳青霉烯类抗生素进行治疗.