烧伤住院患者医院感染细菌菌群分布及耐药性分析

Analysis of the distribution and drug resistance of bacterial flora in hospitalized burn patients

目的了解吉化集团总医院烧伤住院患者医院感染病原菌分布特点及耐药情况。方法收集2005年3月~2008年1月烧伤患者各类临床标本,分离病原菌,K-B纸片扩散法进行药敏试验。结果 112例患者292份标本共分离病原菌356株。肠杆菌科细菌占41.57%（148株）,其中大肠埃希菌58株（占39.19%）、阴沟肠杆菌33株（占22.30%）、变形杆菌25株（占16.89%）;革兰阳性球菌占35.39%（126株）,非发酵菌占21.63%（77株）,其他细菌占2.08%（5株）。烧伤患者检出病原菌耐药性严重,79.31%（46/58）的大肠埃希菌产超广谱β内酰胺酶,88.71%（55/62）的金黄葡萄球菌为耐甲氧西林金黄葡萄球菌,58.97%（23/39）的铜绿假单胞菌为耐药菌株。革兰阳性球菌敏感的药物为万古霉素,阴性杆菌较敏感药物有阿莫西林/克拉维酸和亚胺培南。结论葡萄球菌、大肠埃希菌、肠球菌、铜绿假单胞菌、阴沟肠杆菌、变形杆菌是烧伤患者常见的医院感染菌,且耐药严重,及时监测病原菌的变化及耐药趋势对指导临床用药至关重要。

Objective To investigate the bacterial flora of and drug resistance in burn patients at the General Hospital of the Jilin Chemical Group in Jilin.Methods Clinical samples were collected from burn patients from March 2005 to January 2008.Bacteria were isolated and identified by conventional culture,and the Kirby-Bauer method was used to test drug resistance.Results In total,356 strains of pathogens were isolated from 292 specimens from 112 patients.Of these,148 strains were Enterobacteriaceae（41.57%）.The most common Enterobacteriaceae were E.coli（58 strains,39.19%）,E.cloacae（33 strains,22.30%）,and Proteus（25 strains,16.89%）.There were 126 strains of Gram-positive cocci（35.39%） and 77 strains of non-fermenters（21.63%）.All of the bacterial strains detected were highly drug-resistant.ESBL-producing strains of E.coli accounted for 79.31%（46/58）.Methicillin-resistant strains of S.aureus accounted for 88.71%（55/62） and 58.97%（23/39） of P.aeruginosa strains were drug-resistant.Gram-positive cocci were most sensitive to Vancomycin.Gram-negative bacilli were sensitive to Amoxicillin/clavulanic acid and Imipenem.Conclusion The nosocomial bacteria in burn patients were frequently Staphylococcus,E.coli,Enterococcus,P.aeruginosa,E.cloacae,and Proteus.They were highly drug-resistant.Promptly monitoring changes in pathogenic bacterial flora and their drug resistance to clinical medication is crucial.