91例汶川地震受伤患者病原菌感染情况及药物敏感性分析

Bacterial Infection and Drug Susceptibility Analysis of 91 Victims Wounded in Wenchuan Earthquake

目的探讨转送入医院的91例地震受伤患者病原菌感染及药物敏感情况,为指导地震受伤患者的后续抗感染治疗提供试验依据。方法地震受伤患者的伤口分泌物、痰液、尿液、血液、组织、粪便等标本分别接种相应培养基进行需氧、厌氧和真菌培养,分离菌株用VITEKGN或GP测试卡进行鉴定,真菌用API20C鉴定系统进行鉴定,用K-B法进行药物敏感性试验。结果转送入医院的155例地震受伤患者中91例发生感染,感染发生率58.7%,以>60岁老年人居多;感染部位以呼吸道感染(49.5%)、伤口感染(30.0%)和尿路感染(6.6%)为主;分离的91株病原菌中,革兰阴性菌56株(61.5%)、革兰阳性菌20株(22.0%)、真菌12株(13.2%);分离阳性率较高的病原菌依次为:大肠埃希菌(13.2%)、真菌(13.2%)、不动杆菌属(11.0%)、洋葱伯克霍尔德菌(11.0%)、肠球菌属(9.9%)和金黄色葡萄球菌(9.9%);药敏分析结果显示,革兰阴性菌除铜绿假单胞菌和洋葱伯克霍尔德菌外,对亚胺培南及含酶抑制剂的抗菌药物敏感,而对一、二代头孢菌素类大多耐药;革兰阳性菌对万古霉素、利奈唑胺、喹奴普汀/达福普汀等新型抗菌药物均敏感;真菌药敏情况比较理想,对大多数常用抗真菌药物敏感。结论病原菌培养和药物敏感性分析对指导地震受伤患者抗感染治疗具有重要作用。

OBJECTIVE To investigate the bacterial infection and drug susceptibility of 91 victims wounded in Wenchuan earthquake from Sichuan and provide the laboratory evidences for sequential treatment. METHODS The specimens such as sputum, wound secretion, urine, blood, stool and necrotic tissue from the wounded were cultured on different kinds of culture medium under the aerobic or the anaerobic condition. The isolated bacteria were identified by VITEK GN analyzer or GP cards and API 20C analyzer for fungus. The drug susceptibility tests were carried out by the K-B method. RESULTS 91 wounded （58.7%） were infected, most of them were more than 60 years old. Respiratory tract （49.5% ）, wound （30.0%） and urinary tract （6.6%） were the main infectious sites. Among 91 strains of isolated bacteria, 56 strains were G^- bacilli （61.5%）, 20 were G^＋ bacteria （22.0%） and 12 strains were fungi （13.2%）. The most common species among them were Escherichia coli （13.2%）, fungi （13.2%）, Acinetobacter （11.0%）, Burkholderia cepacia （11.0%）, Enterococcus （9. 9%） and Staphylococcus aureus （9.9 %）. Drug susceptibility results showed that except the Pseudomonas aeruginosa and B. cepacia, the most G bacilli were sensitive to imipenem, but resistant to the first and second-generation cephalosporins. The most G＋ cocci were sensitive to VAN, LNZ and QDA antibiotics, and the fungus were sensitive to antibiotics used commonly in clinical treatment. CONCLUSIONS The pathogenic culture and the drug susceptibility analysis of the victims wounded in Wenchuan earthquake are inportant to guide the anti-infectious treatment.