少数民族聚集地区480例体表创面患者细菌感染与耐药性特点

Characteristics of bacterial infection and drug resistance in wound surface of 480 cases in minority areas

目的了解少数民族聚集地区体表创面患者病原菌分离与耐药情况,为临床合理使用抗生素和有效控制医院感染提供可靠依据。方法收集2019年12月30日-2021年12月31日右江民族医学院附属医院烧伤整形与创面修复外科,符合纳入标准的480例患者的电子病案。采用VITEK微生物分析仪进行细菌的鉴定,AST-GN334、AST-GN335和AST-Gp67药敏卡进行药敏分析,WHONET软件对病原菌的结构特征、常用抗生素的耐药性进行分析。结果共检出革兰阳性菌178株,革兰阴性菌302株,其中金黄色葡萄球菌23.3%(112/480),铜绿假单胞菌17.3%(83/480)、大肠埃希菌12.9%(62/480)、肺炎克雷伯菌7.1%(34/480)、阴沟肠杆菌6.9%(33/480)和鲍曼不动杆菌6.3%(30/480)为优势病原菌;壮、汉、瑶、苗、布依、彝族间的优势病原菌差异无统计学意义(χ^(2)=8.8,P=0.9);优势病原菌在同民族差异有统计学意义(P<0.05);金黄色葡萄球菌对青霉素的耐药率为96.4%(107/111);铜绿假单胞菌对阿莫西林/克拉维酸、米诺环素、头孢西丁等耐药率为100.0%;鲍曼不动杆菌除了对临床常用抗生素有较高的耐药率,对碳青霉烯类药物亚胺培南、美罗培南物耐药率分别为70.0%(21/30)、75.0%(15/20)。结论在少数民族聚集地区,不同民族间体表创面优势菌群无明显差异,而在同民族间的优势菌群有明显差异,该地区临床医生应重视耐药检测结果,合理使用抗生素。

Objective To understand the distribution and drug resistance of pathogenic bacteria in patients with body surface trauma in areas where ethnic minorities gather,and provide a reliable basis for the rational clinical use of antibiotics and effective control of hospital infection.Methods Electronic medical records of 480 patients meeting the inclusion criteria were collected from the Department of Burn Plastic Surgery and Wound Repair of Affiliated Hospital of Youjiang Medical University for Nationalities,between December 30,2019 to December 31,2021.Bacteria were identified by VITEK microbiological analyzer;drug sensitivity was analyzed by AST-GN334,AST-GN335 and AST-Gp67 drug sensitivity cards.The WHONET software was used to analyze the structural characteristics of pathogenic bacteria and the resistance of commonly used antibiotics.Results A total of 178 Gram-positive bacteria and 302 Gram-negative bacteria were detected,including Staphylococcus aureus 23.3%(112/480),Pseudomonas aeruginosa 17.3%(83/480),Escherichia coli 12.9%(62/480),Klebsiella pneumoniae 7.1%(34/480),Enterobacter cloacae 6.9%(33/480),and Acinetobacter baumannii 6.3%(30/480);these were the main pathogens.There was no significant difference in dominant pathogens among Zhuang,Han,Yao,Miao,Buyi,and Yi ethnic groups(χ^(2)=8.8,P=0.9);but the various dominant pathogens had significant differences in the same ethnic group(P<0.05).The resistance rate of S.aureus to penicillin was 96.4%(107/111);the resistance rate of P.aeruginosa to amoxicillin/clavulanic acid,minocycline,and cefoxitin etc was 100.0%;the resistance rate of A.baumannii to carbapenems imipenem and meropenem,in addition to the high resistance rate to commonly used clinical antibiotics,was 70.0%(21/30)and 75.0%(15/20),respectively.Conclusions There was no significant difference in the dominant bacterial community of body surface wound among ethnic groups in the minority gathering areas,however,there were significant differences in the dominant flora among the same ethnic groups.Clinician in this area should pay attention to the drug resistance test results and use antibiotics reasonably.