慢性难愈合创面病原菌分布及体外耐药性分析

Analysis of the distribution of pathogens and drug resistance in chronic wounds

目的了解体表慢性难愈合创面感染病原菌分布及耐药特点,以指导临床治疗。方法回顾海南省人民医院2011年186例慢性难愈合创面住院患者创面分泌物检出的感染病原菌分布及耐药情况。结果 (1)送检标本数196次,共检出病原菌192株,其中革兰阴性(G-)杆菌137株(71.3%),革兰阳性(G+)球菌43株(22.4%),真菌12株(6.3%)。(2)G-杆菌中常见的为铜绿假单胞菌54株(28.1%)、大肠埃希菌18株(9.3%)及鲍曼不动杆菌17株(8.8%);G+球菌中最常见的为金黄色葡萄球菌30株(15.3%)。(3)铜绿假单胞菌对阿米卡星、头孢哌酮/舒巴坦及头孢吡肟较敏感,为75.9%,对氯霉素、复方新诺明100%耐药。大肠埃希菌、鲍曼不动杆菌为常见多重耐药菌,其对三代头孢、氟喹诺酮类、左氧氟沙星等多种抗生素耐药率亦高达70%以上。(4)尚未发现对万古霉素耐药的金黄色葡萄球菌。结论慢性难愈合创面病原菌种类繁多,G-杆菌中大肠埃希菌、鲍曼不动杆菌为慢性创面常见的多重耐药菌。

Objective To understand the surface chronic hard to heal wounds pathogen distribution and drug resistance to guide clinical treatment. Methods Retrospective survey was done on the pathogenic bacteria distribution and drug resistance in 186 hospitalized patients with chronic wounds in Hainan People’s Hospital in 2011. Results （1）In 196 specimens, 192 pathogens were detected, Gram-negative （G-） bacilli 137 （71.3%）, Gram positive （G＋） cocci 43 （22.4%）,fungi 12 （6.3%）. （2） G- bacilli：Pseudomonas aeruginosa was found in 54 （28.1%）, Escherichia coli 18 （9.3%） and Acinetobacter baumannii 17 （8.8%）; G＋ cocci：Staphylococcus aureus was most commonly seen in 30 （15.3%）. （3） The sensitive rate of Pseudomonas aeruginosa was 75.9% to amikacin, cefoperazone / sulbactam, and cefepime; resistance rate was 100% to chloramphenicol, cotrimoxazole. Escherichia coli and Acinetobacter baumannii were the most common multi-drug-resistant pathogens, and their resistance rates to third generation cephalosporins, fluoroquinolones, levofloxacin and other antibiotics were as high as 70% or more. （4） None of Staphylococcus aureus was resistant to vancomycin. Conclusions Chronic wounds are infected with a wide range of pathogens; Among G- bacilli, Escherichia coli and Acinetobacter baumannii are the most common multi-drug-resistant pathogens in chronic wounds.