严重烧伤患者创面病原学改变的研究

Change of etiology of severe burn wound

目的研究10年严重烧伤患者创面病原菌比例发生变化趋势及其耐药性改变,为临床用药提供指导。方法回顾性分析医院2001-2011年严重烧伤患者107例,共送检拭予标本3019份,统计住院第1～8周的病原菌比例,比较2001-2005年和2006-2010年两个时间段金黄色葡萄球菌、链球菌属、铜绿假单胞菌及鲍氏不动杆菌4种病原菌耐药性。结果金黄色葡萄球菌为最常见,占38.00%,鲍氏不动杆菌次之,占16.40%,链球菌属占10.40%,铜绿假单胞菌占10.3%,凝固酶阴性葡萄球菌占10.1%;金黄色葡萄球菌、鲍氏不动杆菌和克雷伯菌的比例从第1～8周,比例显著上升;而链球菌属、铜绿假单胞菌和凝固酶阴性葡萄球菌却逐渐下降;2006-2010年细菌耐药比例显著高于2001-2005年。结论金黄色葡萄球菌占了主要比例,随时可能引起患者创口感染,链球菌属和铜绿假单胞菌所引起的感染发生在烧伤早期,鲍氏不动杆菌则发生在住院>4周,因此根据病原菌分布特点,经验性使用抗菌药物治疗非常重要。

OBJECTIVE To investigate the trend of the proportion of the severe burn wound pathogens and the change of the drug resistance in the last ten decades so as to guide the clinical medication.METHODS A total of 107 cases of patients with severe burn wound in the hospital burn center were retrospectively analyzed from 2001 to 2011.Totally 3019 swab specimens were submitted,the proportion of the pathogens of the first eight weeks was statistically analyzed,the drug resistance of the Staphylococcus aureus,Streptococcus,Pseudomonas aeruginosa,and Acinetobacter baumannii was compared between the segment of 2001-2005 and the segment of 2006-2011.RESULTS S.aureus was the most common species of pathogens,accounting for（38.00%）,followed by A.baumannii（16.40%）,Streptococcus spp（10.40%）,Pseudomonas aeruginosa（10.3%）,and coagulase-negative Staphylococci（10.1%）.The species ratios of S.aureus,Klebsiella and A.baumannii increased significantly from the first week to the eighth week,while those of Streptococcus spp,P.aeruginosa and coagulase-negative Staphylococci decreased during the same period.The drug resistance rate was significantly higher in the 2006-2010 than in 2001-2005.CONCLUSION The S.aureus is the predominant species of pathogens causing wound infections,the infections caused by Streptococcus spp and P.aeruginosa more likely occur in the early stage of burn course,A.baumannii infections occur in 4 weeks after admission.It is very important for the treatment to empirically use antibiotics based on the distribution characteristics of the pathogens.