手外科感染患者创口分泌物细菌分布和药物敏感性分析

Distribution of bacteria of wound secretion and drug susceptibility analysis in infected patients from Department of Hand Surgery

目的:分析手外科感染患者创口分泌物病原菌分布和药敏试验结果,为治疗初期感染患者抗生素的选择提供依据。方法:收集手外科住院患者临床资料,依据创口情况分为3组。第1组为就诊时无创口,术后发生感染患者;第2组为就诊时有污染创口但未发生感染患者;第3组为就诊时已明确发生感染患者。分析各组患者创口分泌物细菌培养和药敏试验结果。结果:获得297例患者的临床资料,其中第1组17例,第2组201例,第3组79例。细菌培养结果共获致病菌54种406株,G+细菌178株(43.8%,178/406),G-细菌228株(56.2%,228/406)。占比较多的4种致病菌为金黄色葡萄球菌(15.8%,64/406)、表皮葡萄球菌(14.0%,57/406)、阴沟肠杆菌(10.3%,42/406)和粘质沙雷菌(9.9%,40/406)。药敏试验,甲氧西林耐药的金黄色葡萄球菌(MRSA)和表皮葡萄球菌检出率分别为9.4%(6/64)和72.0%(46/64),未检出对万古霉素、利奈唑胺和替加环素耐药的葡萄球菌;未检出对碳青霉烯类抗生素耐药的阴沟肠杆菌和粘质沙雷菌。阴沟肠杆菌对头孢曲松敏感率为83.3%(35/42),对头孢他啶敏感率为90.5%(38/42);粘质沙雷菌对头孢曲松敏感率为100.0%(40/40),对头孢他啶敏感率为97.5%(39/40)。结论:一代头孢菌素及耐青霉素酶的青霉素可作为本院手外科感染患者首选经验性用药。对于开放性外伤感染患者,可能有G-杆菌感染时,三代、四代头孢菌素及喹诺酮类抗菌药物可作为首选药物。

Objective:To analyze the results of bacteria distribution of wound secretion and the drug susceptibility test of the infected patients from Department of Hand Surgery,and to provide the evidence for antibiotic selection in the infected patients in early stage of treatment.Methods:The clincal data of hospitalized patients from Department of Hand Surgery were collected.The patients were divided into three groups according to the wound conditions.The patients in Group 1 who had no wound while being in hospital were infected after operation;the patients in Group 2 had the contaminated wound but no infection while being in hospital;the patients in Group 3 had definite infection while being in hospital.The results of bacterium culture of wound secretion and drug susceptibility test of the patients in three groups were analyzed.Results:The clinical data of 297 patients were obtained,including 17 patients from Group 1,201 patients from Group 2,and 79 patients from Group 3.A total of406 strains of 54 species of bacteria were isolated from 297 patients,including 178 strains(43.84%,178/406)gram-positive bacteria and 228 strains(56.2%,228/406)gram-negative bacteria.The four most common strains were Staphylococcus aureus(15.8%,64/406),Staphylococcus epidermidis(14.0%,57/406),Enterobacter cloacae(10.3%,42/406),and Serratia marcescens(9.9%,40/406).The results of drug susceptibility test showed that the detection rates of methicillin-resistant staphylococcus aureus(MRSA)and staphylococcus epidermidis were 9.4%(6/64)and 72.0%(46/64),respectively.There were no vancomycin-resistant,linezolidresistant,and tigecycline-resistant positive strains among Staphylococcus susceptibility;and there were no the carbapenem-resistant positive strains among Enterobacter cloacae and Serratia marcescens.The susceptibility rate of Enterobacter cloacae to ceftriaxone was 83.3%(35/42),and its susceptibility to ceftazidime was 90.5%(38/42).The susceptibility rate of Serratia marcescens to ceftriaxone was 100.0%(40/40),and its susceptibility to ceftazidime was 97.5%(39/40).Conclusion:The first generation of cephalosporin and penicillinase-stabilized penicillin can be used as the preferred empirical antibiotics for the infected patients from Deparment of Hand Surgery in our hospital.The third and fourth generation cephalosporins and quinolones antibiotics can be used as the preferred antibiotics for the infected patients with open trauma as well as the possibility of G-bacillus infection.