严重创伤患者感染病原菌分布及耐药性分析

Clinical Bacterial Isolates in Patients with Severe Injuries:Their Distribution and Resistance

目的分析医院创伤外科严重创伤患者感染病原菌的分布及耐药的发展趋势。方法2003年1月-2007年3月医院收治的严重创伤患者分离所得544株病原菌,分析其种类分布、变迁以及耐药的状况。结果分离病原菌544株,G-菌占64.2%,以铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌为主;G+菌占35.8%,以金黄色葡萄球菌、肠球菌属、凝固酶阴性葡萄球菌为主,混合性感染率为41.0%;严重创伤患者感染病原菌耐药问题严重,碳青酶烯类对G-杆菌的抗菌活性最强,万古霉素对G+球菌活性最强。结论严重创伤患者感染源主要为G-杆菌,病原菌的耐药形式严峻,临床中应合理选用针对性抗菌药物。

OBJECTIVE To study pathogen distribution and resistance of clinical bacterial isolates on patients with severe injuries. METHODS The distributed features of strains of infection germs detected among the patients with severe injuries were statistically analyzed during Jan 2003--Mar 2007. RESULTS In the total 544 strains, the G^- were 62.9% and the most commonly encoantered pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli ;the G^＋ were 37% and the most commonly encountered pathogens were Staphylococcus aureus, Enterococcus, and coagulase-negative Stapylococcus （CNS）. Mixed infection proportion was 41.0%. The bacteria isolated from patients with severe injuries were high resistant to antimicrobial agents. Carbapenems were the most powerful antibiotics against Gram-negative bacilli and vancomycin was the most potent antimicrobial against Gram-positive cocci. CONCLUSIONS The source of infection on patients with severe injuries were Gramnegative bacteria. It is suggested that there be an urgent need for surveillance of bacterial resistance and rational use of antimicrobial agents be emphasised during clinical therapy.