The Characteristics Of Secondary Infection And The Drug Resistance Of Bacteria In Pancreatic Surgery

Objective To search a more reasonable guidance for the application of antibiotics,the pathogen distribution and the drug resistance of secondary infection were analyzed in pancreatic surgical diseases in Union hospital.Methods A retrospective study were made to analyze the pathogen spectrum and the susceptibility test in Pancreatic surgical diseases from Jan 1999 to Jan 2009 in Union hospital. The identification of pathogens and susceptibility test were processed by VITEK-60 automatic microbiological analysis, or manual procedure in accordance with "National clinical laboratory practice agendum ". Quality-control strains were used in the whole procedure for quality control assurance. Resistance analysis used of WHONET5.4 statistics software,which provided by World Health Organization.Results Pancreatic surgical patients had a high incidence of nosocomial infections (15.1%), especially in patients with acute pancreatitis. The main sites of nosocomial infections in pancreatic surgical patients were abdomen, respiratory tract, blood(bacteremia), incision of abdominal wall, accounting for 93.1 percent of all infection sites. Of the isolated pathogens,the bacterial accounted for 74.6%, in which the largest proportion was Gram-negative bacteria, accounting for 60.2 %. The top five bacteria were Escherichia coli (13.98%), Pseudomonas aeruginosa (10.17%), Klebsiella pneumoniae(8.90%), Acinetobacter Baumanii(7.63%), and Enterobacter cloacae (5.93%).Besides,Fungi accounted for 25.4 % of isolated pathogen, while the top four fungi were all Candida,as a total of 23.8% . Cases with severe acute pancreatitis suggested the highest infection rate as 44.2%, accounting for 75 percent of the infected cases. Multiple infections showed larger proportion up to 44.7 percent in pancreatic surgical patients. While the Gram-negative bacteria predominated in all pathogens and manifested the characteristics of drug resistance in high degree,multi-drug resistance and relative susceptibility to Imipenem. Gram-positive cocci manifested resistant to commonly used antibiotics in large proportion, but only relatively susceptibile to vancomycin,Teicoplanin and linezolid. In ESBLs (Extend-Spectrumβ-lactamase bacterias), Escherichia coli (24/33, Klebsiella pneumoniae (9 / 21) showed higher carried rates.Conclusion Pancreatic surgery patients had a high incidence of nosocomial infections,especially in patients with acute pancreatitis. The main infection sites were abdomen, respiratory tract, blood, incision of abdominal wall. Gram-negative bacteria were still the main pathogens in pancreatic surgical infections.They manifested drug resistance in high degree and multi-drug resistance.