骨科感染病原菌谱与抗菌谱3年报告

Pathogenic bacteria and drug-resistance in orthopedics patients: a review of the past three years

[目的]了解骨科病人所感染菌群及其耐药性,指导临床正确应用抗生素。[方法]对骨科门诊及病房细菌感染病人的708份分泌物、脓液等标本进行需氧培养,并对检出菌按K-B法做体外药敏实验。[结果]检出致病菌259株,G+菌占47.9%,其中金黄色葡萄球菌33.0%,凝固酶阴性葡萄球菌14.9%;G-菌占52.1%,其中假单胞菌属占7.3%,不动杆菌属占6.1%。药敏显示革兰阳性球菌对青霉素及苯唑青霉素的耐药率逐年升高,对万古霉素的敏感性最高为100%。革兰阴性杆菌对亚胺培南的敏感率最高,3年平均95.8%,对头孢他啶也较敏感,但有逐年下降的趋势,对环丙沙星、阿米卡星、哌拉西林的耐药率较高,分别为46.0%、47.0%、51.2%。[结论]骨科病人感染的病原菌中,G-杆菌占大多数且有上升趋势,G+球菌感染发生率少于G-杆菌,单菌株以金黄色葡萄球菌占首位。对G-球菌可以选用万古霉素、苯唑青霉素、诺氟沙星等;对G-杆菌可以选用亚胺培南、头孢他啶。革兰阴性杆菌引起骨科感染有上升趋势,耐药也较严重,加强感染菌及药敏检测,合理使用抗生素非常必要。

[Objective] To investigate the pathogenic bacteria and drag resistance in orthopedics patients, so as to guide the clinical use of antibiotics. [ Method] 708 secretions and pus samples from orthopedic outpatients and inpafients were cultured aerobically. The detectable bacteria were subjected to drug sensitivity test in vitro by the K-B assay. [Result] 259 pathogenic strains were detected, and 47. 9% of them were Gram-positive （Staphylococcus aureus, 33.0%： coagulase-negative staphylococci, 14.9% ）, and the remaining 52. 1% were Gram-negative （Pseudomonas, 7. 3%; Acinetobacter, 6. 1% ） . The drag-resistant rate of Gram-positive cocci to penicillin and oxcillin tended to raise over the three years ： however, all the detected Gram-positive cocci were sensitive to vancomycin （ 100% ） . Most Gram-negative bacilli were sensitive to imipenem （95. 8% ） in the past three years and the sensitivity to ceftazidime was also high; however, the sensitivity tended to fall over the past three years. The drug-resistant rates of Gram-negative bacilli to Ciprofloxacin. amikacin and piperacillin were 46. 0%. 47.0% and 51.2% respectively. [ Conclusion] Gram-negative bacilli dominate the pathogenic bacteria in orthopaedic patients and they tend to increase. The incidence of infections by Gram-positive cocci is lower than that of infections by Gramnegative bacilli. In terms of individual bacteria , staphylococcus aureus leads among all of these pathogenic bacteria, Vancomycin, Oxacillin and Norfloxacin are preferred drags against Gram-positive cocci, while imipenem and ceftasidime are preferred for Gram-negative bacilli. The incidence of infections by Gram-negative bacilli tend to raise and drag resistance of Gram-negative bacilli becomes serious： hence, it is cmcialoto emphasize the detection of infectious bacteria and drug sensitive test and to use antibiotics rationally.