多发伤患者感染病原菌分布与耐药性变迁

Distribution of pathogens in patients with multiple injuries and dynamic change of antimicrobial resistance

目的探讨近5年医院创伤外科收治的多发伤患者感染病原菌的构成及耐药谱的动态变化,以指导临床医师合理应用抗菌药物。方法收集2005年1月-2009年12月收治的618例严重多发伤患者,1161份标本分离出834株病原菌,分析其种类、分布以及耐药性的变化。结果分离的病原菌中,革兰阴性杆菌535株占64.1%,革兰阳性球菌281株占33.7%,真菌18株占2.2%;检出菌株前5位依次为鲍氏不动杆菌、金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌和凝固酶阴性葡萄球菌;革兰阳性菌及真菌有明显上升的趋势;革兰阴性杆菌和革兰阳性球菌的耐药率逐渐增加,碳青霉烯类和万古霉素对革兰阴性杆菌及革兰阳性球菌的耐药率较低。结论依据多发伤患者感染病原菌分布及耐药性变迁情况,合理使用抗菌药物,结合伤情综合治疗,改善预后。

OBJECTIVE To discuss the dynamic changes in distribution of pathogens and antimicrobial resistance during the last 5 years in patients with multiple injuries in our department of traumatic surgery, so as to guide clinicians to apply antibiotics appropriately. METHODS A total of 834 bacteria strains isolated from 1161 samples of sputum, blood, secretions and local drainage of suspected infective patients in our department during Jan 2005- Dec 2009, were identified and tested the drug sensitivity. RESULTS G- bacteria were 535 （64.1 %）, G＋ cocci 281 （33.7 % ） and fungi 18 （2.2 % ）. The top five strains were in turn Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and coagulase-negative Staphylococcus. There was an obvious ascending trend on G＋ and fungal infection. CONCLUSION The antibiotics should be reasonably used based on the distribution of pathogens and change of drug resistance, and comprehensive treatment should be performed to improve the prognosis based on the injury condition.