摘要
目的探究泌尿外科腹腔镜手术切口感染病原菌分布、耐药机制及护理防控策略。方法本研究采用回顾性队列研究设计,以2023年1月至2025年2月期间本院泌尿外科收治的180例腹腔镜手术病例为观察对象。通过病案系统调取患者临床资料,对术后切口渗出液样本进行微生物学培养及抗菌药物敏感性检测。根据术后感染情况将病例分为两组:感染组21例(病原学确诊切口感染者),对照组159例(无感染证据)。运用统计学方法分析病原谱特征、耐药模式及感染危险因素,据此构建围术期感染防控方案。结果研究对象中术后切口感染发生率为11.67%(21/180)。共分离出156株病原体,革兰阴性菌98株(占62.82%),其中大肠埃希菌(30.77%)、铜绿假单胞菌(15.38%)和肺炎克雷伯菌(12.82%)为主要致病菌。革兰阳性菌45株(占28.85%),以金黄色葡萄球菌(16.67%)和表皮葡萄球菌(5.77%)居多,真菌13株(占8.33%)。药敏数据显示,革兰阴性菌对氨苄西林和头孢唑林耐药率超70%,但对阿米卡星及哌拉西林/他唑巴坦保持较高敏感性(耐药率<30%)。革兰阳性菌对β-内酰胺类及大环内酯类抗生素普遍耐药(>70%),而糖肽类及噁唑烷酮类药物仍保持完全敏感。高龄(≥60岁)、合并糖尿病、Ⅲ类切口及手术时长≥2 h与感染风险显著相关(单因素P<0.05,多因素OR值2.160-4.642),经Logistic回归验证为独立危险因素(P<0.05)。结论泌尿外科腹腔镜手术切口感染的病原菌主要为革兰阴性菌,切口感染的危险因素包括年龄、合并糖尿病、切口类型、手术时间。临床上应针对上述因素做好相关护理防控措施,同时进行抗感染治疗时应根据药敏结果合理选用抗菌药物,避免耐药菌的出现,以降低患者发生切口感染的风险。
Objective To investigate the distribution of pathogenic bacteria,drug resistance mechanisms,and nursing prevention and control strategies for incisional infections following urological laparoscopic surgery.Methods This study employed a retrospective cohort design,involving 180 patients who underwent laparoscopic surgery in the urology department of our hospital between January 2023 and February 2025.Clinical data were retrieved from the medical record system.Postoperative incisional exudate samples were collected for microbiological culture and antimicrobial susceptibility testing.Based on postoperative infection status,patients were divided into two groups:an infection group(21 cases with etiologically confirmed incisional infection)and a control group(159 cases without evidence of infection).Statistical methods were applied to analyze the pathogen profile,drug resistance patterns,and risk factors for infection,thereby formulating a perioperative infection prevention and control protocol.Results The incidence of postoperative incisional infection was 11.67%(21/180).A total of 156 pathogenic strains were isolated.Gram-negative bacteria accounted for 62.82%(98 strains),with Escherichia coli(30.77%),Pseudomonas aeruginosa(15.38%),and Klebsiella pneumoniae(12.82%)being the predominant pathogens.Gram-positive bacteria accounted for 28.85%(45 strains),primarily Staphylococcus aureus(16.67%)and Staphylococcus epidermidis(5.77%).Fungi accounted for 8.33%(13 strains).Antimicrobial susceptibility data revealed that Gram-negative bacteria exhibited high resistance rates(>70%)to ampicillin and cefazolin,but remained highly susceptible to amikacin and piperacillin/tazobactam(resistance rates<30%).Gram-positive bacteria showed widespread resistance(>70%)to β-lactam and macrolide antibiotics,while remaining fully susceptible to glycopeptides and oxazolidinones.Advanced age(≥60 years),diabetes mellitus,Class Ⅲ incision,and operation duration≥2 h were significantly associated with infection risk(univariate analysis P<0.05;multivariate OR values 2.160-4.642)and were validated as independent risk factors by Logistic regression analysis(P<0.05).Conclusion The main pathogens causing incisional infections after urological laparoscopic surgery are Gramnegative bacteria.Risk factors include advanced age,diabetes mellitus,incision class,and operation duration,Clinical practice should implement targeted nursing prevention and control measures addressing these factors.Furthermore,antimicrobial therapy should be selected rationally based on susceptibility results to prevent the emergence of drugresistant bacteria and reduce the risk of incisional infection.
作者
张玉
黄金明
张静
邓佩琳
张培华
ZHANG Yu;HUANG Jinming;ZHANG Jing;DENG Peilin;ZHANG Peihua(Department of Urology,the First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China;Department of Laboratory Medicine,the First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China;Department of Nursing,the First Affiliated Hospital of Nanyang Medical College,Nanyang,Henan 473000,China;Zhang Zhongjing School of Traditional Chinese Medicine and Materia Medica,Nanyang Instituteof Technology)
出处
《中国病原生物学杂志》
北大核心
2025年第12期1643-1647,共5页
Journal of Pathogen Biology
关键词
泌尿外科
腹腔镜手术
切口感染
病原菌分布
耐药机制
护理防控
urology department
laparoscopic surgery
incisional infection
pathogen distribution
drug resistance mechanism
nursing prevention and control
