开放性手及前臂创伤患者病原菌分布与药物敏感结果分析

Analysis of bacteria distribution and drug sensitivity in open hand and forearm trauma patients

目的了解开放性手及前臂创伤患者常见病原菌的分布与耐药情况，为指导临床抗生素药物的合理使用提供参考依据。方法收集骨科病房内开放性手及前臂创伤感染患者200例，采集病灶伤口分泌物标本进行细菌培养鉴定，并对检出的病原菌按K-B法做体外药物敏感试验。结果分离出病原菌196株，其中革兰阳性细菌82株（41．84％），主要包括金黄色葡萄球菌、表皮葡萄球菌、肠球菌等；革兰阴性细菌114株（58．16％），主要包括大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌等。药物敏感结果显示革兰阳性细菌对常用抗生素药物耐药率最低的是万古霉素；革兰阴性细菌对常用抗生素药物耐药率最低的是亚胺培南；革兰阳性细菌和阴性细菌对青霉素类抗生素均耐药率高。有4例患者伤口分泌物中未分离出病原菌。结论骨科开放性手及前臂创伤感染患者多见，患者细菌耐药情况仍是临床的严峻问题。因此应加强骨科患者的细菌培养及耐药性监测，合理使用抗生素，从而有效降低骨科患者感染的发生率。

Objective To investigate the distribution of pathogens and the development of drug resistance in patients with open hand and forearm trauma and infection, and provide scientific basis for antibiotics selection. Methods A total of 200 patients from the orthopedics ward who sustained infections after open hand and forearm trauma were involved. Secretion from the open wound was collected for bacteria identification, drug susceptibility analysis and resistance detection by the K-B method. Results One hundred and ninety-six pathogen strains were detected. 82 （41.84%） of these were gram-positive bacteria including staphylococcus aureus, staphylococcus epidemaidis, intestinal coccus, etc. 114 （58.16%） were gram-negative bacteria including Escherichia coil, pseudomonas acruginosa, acinetobacter baumannii, etc. The results of drug susceptibility test showed that the lowest antibiotics resistance was vancomycin in gram-positive bacteria. The lowest antibiotics resistance was imipenem in gram-negative bacteria. The highest drug resistance was penicillin for both gram- posirve and gram-negative bacteria. However, no pathogen was isolated from 4 patients. Conclusion Bacterial infection is common in open hand and forearm trauma patients. Currently, bacterial resistance issue is still a serious clinical problem. Strengthening bacteria culture, monitoring drug resistance, and appropriate antibiotics selection could reduce orthopaedic infection rates.