骨创伤感染病原菌分布与耐药性分析

Distribution of pathogens causing bone trauma infections and analysis of drug resistance

目的调查骨与关节化脓性感染的病原菌分布及耐药性,为临床抗菌药物治疗提供依据。方法分析2010年1月-2011年11月骨科收治的272例骨与关节化脓性感染病例分离的病原菌及药敏试验结果。结果表皮葡萄球菌、大肠埃希菌、金黄色葡萄球菌、鲍氏不动杆菌和铜绿假单胞菌分别占21.8%、16.4%、13.7%、12.2%及11.6%;骨科ICU共出现12株极端严重耐药菌,鲍氏不动杆菌和铜绿假单胞菌各6株;加强手卫生和环境清洁后未出现极端严重耐药菌。结论葡萄球菌属是骨与关节化脓性感染的主要致病菌,抗菌药物使用前应常规进行血培养检查;早期感染以革兰阳性球菌为主,住院时间>2周出现鲍氏不动杆菌和铜绿假单胞菌感染,应严格手卫生,预防多药耐药菌感染。

OBJECTIVE To evaluate the pathogens causing bone and joint purulent infections and the bacterial resistance to antibiotics,and to provide reference of clinical antibiotic therapy.METHODS A total of 272 patients who had bone and joint purulent infections from Jan 2010 to Nov 2011 in department of orthopedics were retrospectively analyzed,the results of their bacterial culture and antibiotic susceptibility testing were analyzed.RESULTS The detection rates of Staphylococcus epidermidis,Escherichia coli,S.aureus,Acinetobacter baumannii and Pseudomonas aeruginosa were 21.8%,16.4%,13.7%,12.2%,and 11.6% respectively;there were totally 12 strains of extensively drug-resistant（EDR） bacteria in orthopaedic ICU,including 6 strains of A.baumannii and 6 strains of P.aeruginosa;the extensively drug-resistant（EDR） bacteria did not occur after strengthening the hand hygiene and the cleaning of environment.CONCLUSION Staphylococci are the main pathogens causing bone and joint purulent infections,it is necessary to perform routine blood culture before using antibiotics;gram-positive cocci are the main pathogens causing infections in early stage,then occurred the A.baumannii and P.aeruginosa infections within two weeks of hospital stay;to strictly implement the hand hygiene can prevent the infections caused by multidrug-resistant bacteria.