【摘要】 目的:通过分析本中心耐药菌特点,调整预防性抗菌药物治疗方案,降低经直肠穿刺活检后严重感染并发症发生率。方法:本研究为回顾性研究,将2011年1月至2013年12月间于我院按既往抗菌药物预防方案行经直肠前列腺穿刺活检患者共155例作为对照组,抗菌药物方案为穿刺前日晚起口服乳酸左氧氟沙星分散片,每日2次,每次200 mg,穿刺后继续口服3 d。通过分析本中心耐药菌分布特点,2015年5月至2017年7月于我院行经直肠列腺穿刺活检并接受联合抗菌药物方案的患者167例,设为试验组,抗菌药物方案为穿刺前日晚起口服乳酸左氧氟沙星分散片,每日2次,每次200 mg,至穿刺后第2日停用,穿刺前2 h静脉滴注头孢西丁钠2 g。两组肠道准备方式相同。对照组和试验组患者的年龄分别为(68.68±8.12)岁和(68.72±7.51)岁,PSA水平分别为(19.78±21.57)μg/L和(21.15±42.63)μg/L。所有患者均采用超声引导下10针及以上经直肠前列腺穿刺活检,对照组和试验组患者穿刺针数分别为(11.68±1.44)针和(11.77±1.02)针。将严重感染定义为穿刺后1周内出现下尿路症状合并全身炎症反应综合征,分析两组患者穿刺后严重感染的发生率。结果:对照组和试验组术后严重感染发生率分别为5.8%(9/155)和0.6%(1/167),差异有统计学意义(P<0.05);对照组中血培养6例阳性,均为大肠埃希菌,其中5例为产超广谱β内酰胺酶菌株(ESBL+),6例血培养阳性患者中,对氟喹诺酮类抗菌药物均耐药,阿米卡星敏感者4例,6例患者头孢西丁、头孢哌酮舒巴坦、亚胺培南均敏感。试验组1例严重感染患者血培养阴性。结论:根据本中心耐药菌分布特点,经直肠前列腺穿刺活检前加用单剂量头孢西丁预防感染可降低术后严重感染发生率。更多还原

【Abstract】 Objective:To evaluate the effect of cefoxitin prophylactic in reducing the incidence of severe infection after transrectal prostate biopsy(TRPB).Methods:This retrospective study included 155 cases of TRPB with a 5-day administration of oral levofloxacin at 200 mg bid(the control group)and another 167 cases with a 3-day administration of oral levofloxacin at the same dose plus intravenous cefoxitin at 2.0 g 2 hours before TRPB(the experimental group)according to the distribution characteristics of drug-resistance bacteria in our department.The patients of the control and experimental groups were aged(68.68±8.12)and(68.72±7.51)years,with PSA levels of(19.78±21.57)and(21.15±42.63)μg/L,involving(11.68±1.44)and(11.77±1.02)biopsy cores,respectively.Comparisons were made between the two groups of patients in the incidence rate of severe infection,which was defined as lower urinary track symptoms plus the systemic inflammatory response syndrome(SIRS)within 7 days after TRPB.Results:The incidence rate of postoperative severe infection was significantly lower in the experimental group than in the control(0.6%[1/167]vs 5.8%[9/155],P<0.05).Blood cultures revealed positive E-coli strains in 6 cases in the control group,including 5 ESBL-positive and 4 quinolone-resistant and amikacin-sensitive cases,all sensitive to cefoxitin,cefoperazone/sulbactam and imipenem.The only one case of severe infection was shown to be negative in blood culture.Conclusion:Preoperative intravenous administration of cefoxitin according to the specific distribution characteristics of drug-resistance bacteria can significantly reduce the incidence of severe infection after TRPB.更多还原