台州医院1996～2003年烧伤住院患者创面细菌学分析

An analysis of bacterial profile of burn wounds in Taizhou Hospital from 1996 to 2003

目的了解我院烧伤科住院患者烧伤创面细菌学变迁情况,为烧伤感染防治提供依据。方法收集1996～2003年我院烧伤科烧伤创面培养细菌1079株,应用法国Biomerieux公司VITEK60全自动细菌鉴定及药敏系统进行细菌鉴定及药敏试验。以2000年新老病房搬迁为界,1996年1月～1999年12月收集标本为Ⅰ组,2000年1月～2003年12月为Ⅱ组进行分析比较。结果革兰阴性杆菌是主要的烧伤创面培养菌,其中不动杆菌占首位。革兰阳性球菌中金黄色葡萄球菌居第1位。Ⅱ组不动杆菌、铜绿假单胞菌、总革兰阴性杆菌检出率显著下降,金黄色葡萄球菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、洋葱伯克霍尔德菌及总革兰阳性球菌检出率则显著增高,真菌占检出菌种第4位。Ⅱ组检出的细菌菌株对所试抗菌药物的敏感性较Ⅰ组普遍降低。结论检出菌株因抗菌药物应用、早期手术、病房条件的改善而发生变化;临床应重视细菌学调查工作,并采取综合措施延缓细菌耐药的发展。

Objective To observe the changes in bacterial profile of burn wounds in Burn Unit of Taizhou Hospital. Methods The specimens were collected from burn wounds of patients admitted from 1996 to 2003. The specimens were cultured and the bacterial sensitivity to antimicrobial agents was tested.The data were analyzed for two periods the first period was from January 1996 to December 1999 and the second from January 2000 to December 2003. Results Total 1079 bacterial strains were isolated by wound swabs. In general,Gram-negative bacilli were the main parts of the bacteria on burn wound, among which acinetobacter ranked the first. Staphylococcus aureous ranked the first among the isolated Gram-positive cocci. In contrast with the 1st period, the isolation rate of acinetobacter, pseudomonas aeruginosa and total Gram-negative bacilli decreased significantly in 2nd period,while the rate of Staphylococcus aureous, coagulase-negative Staphylococcus, lebsiella pneumoniae, Burkholderia cepacia and total Gram-positive cocci increased markedly. In both periods fungus ranked the fourth among the bacteria. Almost all isolated bacteria with the resistance to frequently used antibiotics were increased in the 2nd period. Conclusion The changes of the bacterial profile on burn wound in Burn Unit might be related to the wider use of broad spectrum antibiotics, to the earlier escharectomy and to the improvement of the ward condition.