开放性骨折患者伤口分泌物的细菌培养及耐药性分析

Bacterial culture about wound secretions from patients with open fracture and analysis of drug resistance

目的探讨开放性骨折患者伤口分泌物的细菌培养及耐药性,为临床抗感染治疗提供依据,使临床能够对开放骨折感染有效的控制。方法选取2010年2月-2011年5月于医院进行治疗的158例开放性骨折患者为研究对象,将患者伤口清创前和清创后8h分别取分泌物进行培养,将两组检出的细菌对9种抗菌药物耐药率进行统计及比较。结果清创前检出大肠埃希菌148株、金黄色葡萄球菌121株、铜绿假单胞菌96株、克雷伯菌属84株、不动杆菌属72株;清创后检出大肠埃希菌28株、金黄色葡萄球菌32株、铜绿假单胞菌17株、克雷伯菌属13株、不动杆菌属31株,清创前后均以革兰阴性菌感染为主,培养出的细菌对头孢哌酮耐药性明显低于其他抗菌药物;清创前的菌株数明显多于清创后,革兰阴性菌的频率明显高于革兰阳性菌,差异均有统计学意义(均P<0.05)。结论骨科开放伤口感染以革兰阴性菌为主,骨折开放伤口应该予以及时有效的清创,积极预防感染。

OBJECTIVE To explore the drug resistance of the pathogens isolated from wound secretions of patients with open fracture,to give some of the clinical reference to make effective infection control. METHODS A total of 158 cases of open fractures patients in our hospital from Feb 2010 to May 2011 were selected as research object.The wound debridement in patients before and 8 hours after debridement secretions were collected for culture,then the bacteria resistance rates of the two bacterial strains to 9 antibiotics were taken for statistics and compared. RESULTS Before debridement 148 strains of Escherichia coli were detected,Staphylococcus aureus was 121 strains,Pseudomonas aeruginosa was 96 strains,Klebsiella pneumoniae 84 strains,and Acinetobacter were 72 strains.The above bacteria occupied the majority of bacterial infection.After debridement,E.coli was 28 strains,S.aureus was 32 strains,P.aeruginosa was 17 strains,K.pneumoniae was 13 strains,Acinetobacter was 31 strains.G-bacteria were the main bacteria before and after debridement.The resistance df bacteria cultivated to cefoperazone was apparently.The number of strains was significantly greater after debridement than before.G-bacteria was significantly higher than the frequency of G＋ bacteria.Lower than other antibacterials（P〈0.05）.There was significant difference. CONCLUSION Orthopaedic open wounds are mainly infected by G-bacteria.Open fracture should be given the timely and effective wound debridement to prevent infection actively.