中国人群体表慢性难愈合创面病原微生物学特征分析

Signature analysis of pathogenic microorganism on chronic cutaneous wounds of the Chinese people

目的:研究体表慢性难愈合创面病原微生物学特征,为选择正确的创面抗感染治疗方法提供依据。方法:采用多中心横断性病例回顾调查研究的方法,对2007—2008年我国17家医院中因体表慢性难愈合创面住院治疗患者的住院病历中有关细菌病原学特征进行记录,分析其规律。结果:共有1 488 201个病案被纳入观察对象,从中获得符合入选标准的2 513例体表慢性难愈合创面患者作为研究对象,年龄18 d～96岁,中位年龄58岁。660个病案记录了细菌培养结果,1 853个病案无记录,144个记录显示培养结果为阴性,4个记录无法进行分类。记录革兰阴性杆菌36种,347株;革兰阳性球菌17种,265株;革兰阳性杆菌5种,7株;革兰阴性球菌1种,4株;真菌7种,42株;共计可分类阳性记录66种,665株。金黄色葡萄球菌(不含耐甲氧西林金黄色葡萄球菌)是最常见致病菌,其次为铜绿假单孢菌、大肠埃希菌、凝固酶阴性葡萄球菌。革兰阳性杆菌、革兰阴性球菌少见。白色念珠菌为最常见真菌。结论:体表慢性难愈合创面感染病原微生物种类繁多、特征复杂,提示在创面病原微生物的抗感染治疗过程中应加强并重视对创面的细菌培养,这样才能给予针对性强的抗生素或其他方式治疗,从而避免抗生素的联用及滥用,降低抗生素滥用造成的耐药性,以及抗生素过度使用而导致的医药费用的额外增加。

Objective .. To analyze the signatures of pathogenic microorganism on chronic cutaneous wounds of the Chinese people so as to provide evidences for choosing the correct antibacterial methods. Methods：A multicentric, cross-sectional and retrospective survey was performed in patients who were undergoing treatment for chronic cutaneous wounds samples from 17 hospitals from 2007 to 2008. Results of the study of pathogenic microorganisms were collected and analyzed from the records of their medical records. Results： The records of I 488 201 cases were retrieved, and 2 513 patients who underwent treatment of chronic cutaneous wounds, with their age ranged from 18 days to 96 years （medium age 58 years）, were studied. Records of bacterial culture results were found in 660 cases, but .there was none in 1 853 cases. In 660 cases with the bacteial culture records, 144 were recorded as negative, and in 4 records the result could not be classified. There were 36 species of Gram-negative rods with a total of 347 strains; 17 species of Gram-positive cocci,265 strains＇ 5 species of Gram-positive rods, 7 strains; 1 specy of Gram-negative coccus,4 strains; 7 species of fungi,42 strains. Among them there were 66 pathogenic microorganism, with a total of 665 strains, that could be classified. Staphylococcus aureus （not including MRSA） was the most common pathogenic microorganism, followed by Pseudomonas aeruginosa, Escherichia coli, and co- agulase negative staphylococcus. Gram-positive rods and Gram-negative cocci were rare. Candida albicans was the most common fungus. Conclusions： There is a large number of pathogenic microorganisms found on chronic cuta- neous wounds, resulting in a complication situation. It suggests that obtaining bacterial culture before antibacterial drugs are given should be emphasized. Optimal antibiotics and other antibacterial methods could only be chosen when the infections microorganism（s） is truly identified, so as to avoid abuse of antibiotic therapy. It is also helpful to decrease drug resistance caused by antibiotic abuse and unnecessary expenditure of excessive antibiotics usage.