2006—2011年我科烧伤病人主要菌群分布及耐药情况调查

INVESTIGATION OF MAIN BACTERIAL FLORA DISTRIBUTION AND RESISTANCE STATUS IN BURN PATIENTS TREATED IN OUR BURN WARDS DURING 2006—2011 PERIOD

目的了解我科近5年住院病人感染的几种主要病原菌分布特点及其药物敏感情况,为烧伤科抗感染治疗提供科学依据。方法回顾性分析2006—2011年我科133例住院病人细菌培养及药敏结果,细菌鉴定及药敏试验采用WalkAway-96全自动微生物细菌鉴定仪。结果 133例住院病人送检的标本中分离出308株细菌,其主要流行病菌依次为铜绿假单胞菌(23.05%)、金黄色葡萄球菌(21.43%)、鲍曼不动杆菌(11.04%)、嗜麦芽黄单胞菌(4.87%)、阴沟肠杆菌(4.87%)、肺炎克雷伯菌(4.22%)。金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌占90.91%,其较为敏感的药物为氯霉素、复方新诺明及四环素,未发现对糖肽类药物的耐药菌株;铜绿假单胞菌及嗜麦芽黄单胞菌仅对碳氢酶烯类药物保留较高的敏感率,而对哌拉西林-他唑巴坦及头孢哌酮-舒巴坦耐药严重;阴沟肠杆菌及肺炎克雷伯菌中产超广谱β内酰胺酶菌株超半数,敏感率最高的药物是美罗培南(100.00%),对亚胺培南的敏感率在60%～80%之间;肺炎克雷伯杆菌对哌拉西林-他唑巴坦尚保留一定的敏感性(66.67%),阴沟肠杆菌对罗米沙星的敏感率为90.00%。结论烧伤病房细菌耐药严重,必须提高标本送检率,为临床抗菌治疗提供科学依据。

Objective To understand the distribution and drug resistance of the main bacteria that infected burn patients treated in our department in these five years and provide a scientific basis for anti-infective therapy of burn. Methods A retrospective analysis was done in 133 burn patients,who were hospitalized during 2006—2011 period,in terms of the results of bacterial culture and drug sensitivity test.The identification of bacteria and drug sensitive test were carried out by employing WalkAway 96 automated microbiology system. Results In the samples collected from the 133 patients,308 strains were isolated.The main pathogenic bacteria were in order of Pseudomonas aeruginosa（23.05%）,Staphylococcus aureus（S.aureus,21.43%）,Acinetobacter baumannii（11.04%）,Xanthomonas maltophilia（4.87%）,Enterobacter cloacae（4.87%） and Klebesiella pneumonia（4.22%）.Among the S.aureus,the incidence of meticillin resistance S.aureus was 90.91%,which were more sensitive to chloromycetin,trimethoprim-sulfamethoxazole and tetracycline,no glycopeptides-resistant strains were found.Pseudomonas aeruginosa and Xanthomonas maltophilia were relatively higher sensitive only to carbopenems and greatly resistant to both Piperacillin tazobactam and Cefopcrazone Sulbactam.Enterobacter cloacae and Klebesiella pneumonia produced extended-spectrum β-lactamases,which were most sensitive to Meropenem（100.00%）,and 60%-80% sensitive to imipenem.Klebesiella pneumonia still reserved a certain sensitivity to Piperacillin tazobactam（66.67%）,while Enterobacter cloacae remained highly sensitive to Romilxacin（90.00%）. Conclusion Being serious bacterial drug resistance in burn ward,the rate of submitted samples should be increased in order to provide more sufficient information for clinical antibiotic therapy.