骨科开放性伤口的细菌学分析

Microbiology of wound infections in open fracture patients

目的调查分析骨科开放性伤口的细菌学特点及其药敏试验结果,指导临床抗菌药物的合理应用。方法采用回顾性方法调查2008年11月-2011年5月收治的骨科开放性骨折患者的伤口感染发生情况,并分析感染患者的细菌学特点和药敏试验结果。结果共有54例开放性骨折患者发生伤口感染,细菌培养阳性患者共39例,细菌检出率为72.2%;共培养出95株病原菌,其中革兰阴性杆菌56株占58.9%,革兰阳性球菌39株占41.1%;伤口感染病原菌的检出率由高至低依次为铜绿假单胞菌、粪肠球菌、鲍氏不动杆菌、阴沟肠杆菌、肺炎克雷伯菌、溶血葡萄球菌、金黄色葡萄球菌、大肠埃希菌,分别占137%、137%、11.6%、8.4%、8.4%、7.4%、6.3%、6.3%。结论骨科开放性伤口感染以革兰阴性杆菌为主,且对多种抗菌药物明显耐药;医务工作者应重视开放性创口病原菌培养及药敏结果,合理使用抗菌药物,提高抗菌药物使用效率。

OBJECTIVE To analyze the bacterial characteristics of the pathogens causing wound infections in open fracture patients so as to guide the reasonable use of antibiotics. METHODS The open fracture patients who treated in hospital from Nov 2008 to May 2011 were enrolled in the study, the incidence of the wound infections was retrospectively investigated, the bacterial characteristics and the result of the drug susceptibility testing were analyzed. RESULTS There were totally 54 open fracture patients with wound infections and 39 cases with the positive bacterial culture, the detection rate of the bacteria was 72. 2% ; totally 95 strains of pathogens were isolated, including 56 （58.9 %） strains of gram-negative bacilli and 39 （41.1%） strains of gram-positive cocci; the detection rates of the pathogens causing wound infections from high to low as follows： Pseudomonas aeruginosa （13. 7 % ）, Enterococcus f aecalis （ 13. 7 % ）, Acinetobacter baumannii （ 11. 6 %）, Enterobacter cloacae （ 8. 4 % ）, K lebsiella pneumo niae （8.4%）, Staphylococcus haemol yticus （ 7. 4 %）, Escherichia coli （6.3%）, and S. aureus （6. 3%）. CONCLUSION The gram-negative bacilli are the predominant pathogens causing wound infections in open fracture patients,which are significantly multidrug-resistant; the medical staff should attach great importance to the culture of pathogens and the drug susceptibility testing result and reasonably use antibiotics to raise the efficiency.