结直肠癌住院患者术后感染的病原菌分布特征及风险因素分析OA

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 in-fection 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 pneu-moniae(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 albu-min 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.