实用肿瘤杂志

目的 分析结直肠癌（colorectal cancer, CRC）住院患者术后感染的病原菌分布及耐药情况，探讨术后感染的风险因素，为抗菌药物合理使用和感染防控提供参考。方法 回顾性收集2018年1月至2024年12月广州医科大学附属中医医院确诊CRC并接受手术治疗的1 200例患者，其中术后发生感染179例（术后感染组），采用近邻匹配法选取同期未发生术后感染患者179例作为对照组。分析术后感染组病原菌种类及药物敏感结果，并比较两组临床资料。采用单因素和多因素logistic回归分析筛选术后感染的独立风险因素。结果 179例术后感染患者中，泌尿道感染67例（37.43%），血流感染60例（33.52%），共分离出179株病原菌。其中，大肠埃希菌81株（45.25%）[产超广谱β-内酰胺酶（extended-spectrum β-lactamases,ESBLs）菌株49株（60.49%）]，肺炎克雷伯菌21株（11.73%），铜绿假单胞菌18株（10.06%），金黄色葡萄球菌和其他球菌23株（12.84%），真菌20株（11.17%）。药物敏感试验结果显示，大肠埃希菌对亚胺培南[4株（4.94%）]和哌拉西林/他唑巴坦[5株（6.17%）]的耐药率较低。产ESBLs菌株对头孢菌素类和氨曲南等药物的耐药率均高于非产ESBLs菌株（均P<0.05）。肺炎克雷伯菌和铜绿假单胞菌对部分头孢菌素的耐药率较高。革兰氏阳性菌对四环素[17株（73.91%）]和青霉素G[14株（60.87%）]的耐药率较高。单因素分析显示，体质量指数（body mass index, BMI）、合并糖尿病与高血压、术前白蛋白水平、手术时间、术中出血量、肿瘤位置、病理分化程度、淋巴结转移和肿瘤分期均与术后感染相关（均P<0.05）。多因素logistic回归分析显示，BMI(OR=1.091,P=0.002)、合并糖尿病（OR=3.435,P<0.01）、手术时间（OR=1.012,P=0.003）和肿瘤分期Ⅲ～Ⅳ期（OR=4.289,P<0.01）均为CRC患者术后感染的独立危险因素，而术前白蛋白水平为保护因素（OR=0.883,P<0.01）。结论 CRC术后感染以血液和泌尿道感染为主；病原菌以大肠埃希菌为主，且耐药性复杂。CRC术后感染与代谢状态、手术创伤和肿瘤进展密切相关，需结合病原菌监测与风险因素管理优化抗菌药物的使用。

Objective To analyze the distribution and drug resistance of pathogens causing postoperative infection among hospitalized colorectal cancer(CRC) patients and the risk factors for postoperative infection, providing reference for rational use of antibiotics and infection control. Methods A retrospective analysis was conducted among 1 200 patients diagnosed with CRC and treated surgically at the Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University from January 2018 to December 2024. A total of 179 patients with postoperative infection were included in the infection group, and 179 patients without postoperative infection were selected as the control group by nearest-neighbor matching. Pathogen species and antimicrobial susceptibility results in the infection group were analyzed. Clinical data were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. Results In the infection group, urinary tract infection occurred in 67 cases(37.43%) and bloodstream infection in 60 cases(33.52%). A total of 179 pathogen strains were isolated. Escherichia coli was the most common pathogen(81 strains, 45.25%), including 49 extended-spectrum β-lactamase(ESBL)-producing strains(60.49%). Other pathogens included Klebsiella pneumoniae(21 strains, 11.73%), Pseudomonas aeruginosa(18 strains, 10.06%), Staphylococcus aureus and other cocci(23 strains, 12.84%), and fungi(20 strains, 11.17%). Antimicrobial susceptibility testing showed that Escherichia coli had lower rates of resistance to imipenem(4 strains, 4.94%) and piperacillin/tazobactam(5 strains, 6.17%). ESBL-producing strains showed higher rates of resistance to cephalosporins and aztreonam than non-ESBL-producing strains(all P<0.05). Klebsiella pneumoniae and Pseudomonas aeruginosa showed relatively high rates of resistance to some cephalosporins. Gram-positive bacteria showed high rates of resistance to tetracycline(17 strains, 73.91%) and penicillin G(14 strains, 60.87%). Univariate analysis showed that body mass index(BMI), diabetes/hypertension, preoperative albumin level, surgical duration, intraoperative blood loss, tumor location, histological differentiation, lymph node metastasis, and tumor stage were associated with postoperative infection(all P<0.05). Multivariate logistic regression showed that BMI(OR=1.091, P=0.002), diabetes(OR=3.435, P<0.01), surgical duration(OR=1.012, P=0.003), and stage Ⅲ-Ⅳ tumor(OR=4.289, P<0.01) were independent risk factors for postoperative infection in CRC patients, whereas preoperative albumin level was a protective factor(OR=0.883, P<0.01). Conclusions Postoperative infections in CRC patients are primarily bloodstream and urinary tract infections, with Escherichia coli being the dominant pathogen showing complex resistance patterns. Postoperative infection is closely related to metabolic status, surgical trauma, and tumor progression. Optimizing antimicrobial use requires integrating pathogen surveillance with effective management of identified risk factors.