手外伤感染的菌种构成及耐药性分析

The pathogen group and their drug-resistance analysis in hand infection after trauma

目的通过对手外伤感染创面细菌培养结果进行菌种分布和耐药情况分析，为手外科感染控制及临床合理用药提供依据。方法收集沈阳医学院附属中心医院2010年1月1日-2014年12月31日手外伤感染患者的分泌物标本进行细菌培养，分离致病菌，对其菌种分布及耐药情况进行分析。结果共分离细菌915株，其中革兰氏阴性杆菌738株，占80．6％，革兰氏阳性球菌169株，占18．5％；真菌8株，占0．9％。致病菌中以铜绿假单胞菌检出率最高258株（28．2％），其次为金黄色葡萄球菌97株（10．6％），鲍曼不动杆菌67株（7．3％）。肠杆菌科细菌对美罗培南、亚胺培南和头孢哌酮／舒巴坦耐药率较低，分别是5．1％，6．8％和9．2％；非发酵菌对多粘菌素B和头孢哌酮／舒巴坦耐药率较低，分别是4．2％和7．5％；葡萄球菌和链球菌／肠球菌属对万古霉素敏感。结论手外科感染的菌种分布和耐药情况有自己的特点．不同于其他部位的感染．应将细菌培养作为抗菌药物使用的券者．

Objective To investigate the distribution of common species of pathogens causing infections in hand surgery department and analyze the drug resistance so as to provide basis for the clinical study. Methods The pathogens causing infections in hand surgery department from 2010.01.01 to 2014.12.31 were analyzed for their drug sensitivity with MIC method, and the results were carried out for statistical analysis. Results Among the 915 pathogens isolated, there were 738 （80.6%） strains of gram-negative bacteria,; there were 169（18.5%） strains of gram-positive bacteria, and there were 8（0.9%） strains of fungi. Among which Pseudomonas aeruginosa was the dominant, 258 strains（28.2%）, followed by Staphylococcus aureus, 97 strains （10.6%） and Acinetobacter baumannii 67 strains （7.3%）. The enterobacteriaceae were most susceptible to imipenem, meropenem and cefoperazone/sulbactam, with the drug resistance rate of 5.1%, 6.8%, and 9.2; The non-fermentative bacilli were most susceptible to polymexin B and cefoperazone/sulbactam, with the drug resistance rate of 4.2%, and 7.5%; the gram-positive bacteria were most susceptible to vancomycin. Conclusion Hand infection has its own pathogen distribution and drug resistance characters, not the same like other infections, so it is necessary for the hospital to perform the symptomatic treatment based on the drug susceptibility testing.