皮肤软组织感染病原菌分布及耐药性分析

Analysis of bacterial spectrum and susceptibility tests of pathogens causing skin and soft tissue infection

目的调查皮肤软组织感染病原菌的种类及耐药性,为临床合理使用抗菌药物提供科学依据。方法利用WHONET 5.6对2009年1月至2011年12月皮肤软组织感染患者脓液或分泌物细菌培养及药敏试验结果进行回顾性分析。结果共分离菌株444株,金黄色葡萄球菌(SAU)分离率居第1位,171株占38.5%;表皮葡萄球菌居第2位,54株占12.2%;铜绿假单胞菌第3位,43株占9.7%;头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星、亚胺培南和美罗培南对革兰阴性杆菌有较好的抗菌活性(耐药率≤3.3%);金黄色葡萄球菌对青霉素和红霉素的耐药率为93.6%和65.0%,对呋喃妥因、利奈唑胺、利福平、莫西沙星和左旋氧氟沙星耐药率为0%、0%、1.4%、2.2%和9.3%,未检出万古霉素耐药株;耐甲氧西林金黄色葡萄球菌(MRSA)检出率25.7%(44/171);MRSA和甲氧西林敏感金黄色葡萄球菌(MSSA)对氨苄西林/舒巴坦、利福平、莫西沙星三种药物的敏感性差异有统计学意义。结论引起皮肤软组织感染病原菌以阳性球菌尤其是金黄色葡萄球菌为主,临床上应尽量根据药敏试验结果选用抗生素,合理用药。

Objective To investigate pathogenic species and antimicrobial resistance of bacteria in skin and soft tissue infection in order to provide the scientific evidence for clinical reasonable use of antibiotics.Methods A retrospective analysis was carried out among the pus culturing results from patients with skin and soft tissue infection during the period of January 2009 to December 2011 by WHONET 5.6 software.Results A total of 444 strains were isolated.The top three of pathogenic bacteria were Staphylococcus aureus 38.5%（171）,Staphylococcus epidermidis 12.2%（54） and Pseudomonas aeruginosa 9.7%（43）.Gram-negative bacilli was susceptible to imipenem,meropenem,cefoperazone/sulbactam,piperacillin/tazobactam and amikacin.The rates of Staphylococcus aureus resistant to penicillin and erythromycin were 93.6% and 65.0%;to nitrofurantoin,linezolid,rifampin,moxifloxacin and levofloxacin were 0%,0%,1.4%,2.2% and 9.3%,respectively.No vancomycin-resistant strains were detected;The detection rate of Methicilli-resistant S.aureus（MRSA） was 25.7%.There were significant differences in resistance to ampicillin/sulbactam,rifampin and moxifloxacin between MRSA and MSSA.ConclusionThe pathogenic bacteria of skin and soft tissue infection are mainly Gram positive,mostly Staphylococcus aureus.Antibiotics should be applied according to the drug sensitivity tests to avoid inappropriate use.