化脓性骨髓炎病原菌培养及耐药性分析

Analysis of bacterial culture and drug resistance in suppurative osteomyelitis

目的总结骨髓炎的临床特征、病原菌分布特点及耐药情况,为临床提供合理的治疗指导。方法回顾性分析2004年9月至2008年6月收治的63例急性血源性骨髓炎和104例慢性化脓性骨髓炎患者病原菌分布情况及抗菌药物敏感试验资料。结果63例急性血源性骨髓炎有57株细菌生长,共培养出4种细菌,无多重感染;104例慢性化脓性骨髓炎有91株培养结果阳性,共培养出149株、8种病原菌,其中14例培养出3株,30例培养出2株,47例培养出单株;革兰阳性(G+)球菌77株,革兰阴性(G-)杆菌69株,真菌3株,大部分细菌对抗菌药物产生耐药。结论与急性骨髓炎多为单种G+球菌感染不同,慢性化脓性骨髓炎细菌分布发生较大变化,存在多重感染。另外,G+球菌感染率下降,铜绿假单胞菌感染上升。对不同类型化脓性骨髓炎的治疗应根据药敏试验结果选择敏感抗菌药物,制订合理的治疗方案。

Objective To summarize clinical feature, bacterial distribution and drug resistance in different types of osteomyelitis, so as to provide guidance for rational therapy. Methods Retrospective analysis was performed on the clinical data of bacterial distribution and antibiotic sensitivity test results of 63 patients with acute hematogenous osteomyelitis （acute group） and 104 pationts with chronic pyogenic osteomyelitis （chronic group） in our hospital from September 2004 to June 2008. Results Fifty-seven strains were isolated in acute group, and 4 species of bacteria were identified. No multiple infections occurred. Ninety-one strains were isolated in chronic group, and 8 species of bacteria were identified. In chronic group, 3 strains were positive in 14 cases, 2 strains positive in 30 cases, only one strain positive in 47 cases; bacterial identification： gram positive cocci 77 strains; gram negative bacilli 69 strains; fungi 4 strains. Most isolates were resistant to antibacterials. Conclusion The infection types of chronic pyogenic osteomyelitis change a lot, displaying multiple infections, different from acute pyogenic osteomyelitis which displays infection of single gram positive coccus. Besides, the infection rate of gram positive coccus is decreasing, and that of pseudomonas aeruginosa is increasing. The clinicians should use antibiotics rationally according to drug sensitivity test results in different types of suppurative osteomyelitis.