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.

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. [ABSTRACT FROM AUTHOR]