烧伤患者创面分离病原菌分布及耐药性分析

Distribution and drug resistance of pathogens isolated from wounds of burn patients

目的探讨医院3年烧伤患者创面分离的病原菌分布及其耐药现状,为临床合理用药提供参考依据。方法对2008年1月-2011年1月医院收治的324例烧伤患者进行创面培养,对其病原学及抗菌药物敏感性结果进行分析。结果 324例烧伤患者中有286例发生创面感染,其中13例发生混合感染;共培养出298株病原菌,其中革兰阴性杆菌219株占73.49%;革兰阳性球菌63株占21.14%;真菌16株占5.37%;前3位病原菌依次为铜绿假单胞菌、大肠埃希菌、鲍氏不动杆菌,分别占25.84%、18.12%、14.43%;铜绿假单胞菌和鲍氏不动杆菌的多药耐药率分别高达71.43%和86.05%,两者对阿米卡星和头孢哌酮/舒巴坦的敏感率较高,而对氟喹诺酮类抗菌药物及三代头孢菌素的耐药率较高;大肠埃希菌和肺炎克雷伯菌产ESBLs率分别高达75.93%和79.71%;在革兰阳性菌中耐甲氧西林表皮葡萄球菌(MRSE)和耐甲氧西林金黄色葡萄球菌(MRSA)的分离率分别为71.43%和72.00%,葡萄球菌属对青霉素、红霉素严重耐药,但对万古霉素、利奈唑胺的敏感性高;真菌则主要以白色假丝酵母菌为主。结论烧伤患者分离的病原菌仍以革兰阴性菌为主,革兰阳性菌和真菌分离率逐渐上升,相关菌株耐药性严重,及时监测病原菌耐药性对指导合理用药至关重要。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens isolated from the wounds of the burn inpatients during the 3 years so as to guide the reasonable use of antibiotics.METHODS A total of 324 burn patients who enrolled the hospital from Jan 2008 to Jan 2011 were cultured for the wounds,the etiology and the results of the drug susceptibility testing were analyzed.RESULTS Among 324 burn inpatients,there were 286 patients who were with wound infections.Totally 298 strains of pathogens were isolated,including 219 strains of gram-positive strains（73.5%）,63 strains of gram-negative strains（21.1%）and 16 strains of fungi（5.4%）.The top three species of pathogens were Pseudomonas aeruginosa（25.84%）,Escherichia coli（18.12%）,and Acinetobacter baumannii（14.43%）.Among the non-fermenting bacteria,the multidrug-resistant rates of P.aeruginosa and A.baumannii were as high as 71.43% and 86.05%,respectively.Both of them were more sensitive to amikacin and cefoperazone/sulbactam,while more resistant to fluoroquinolone and a variety of third-generation cephalosporins.The positive rates of ESBLs-producing E.coli and K.pneumoniae were 75.93% and 79.71%.Among the gram-positive bacteria,the isolation rates of MRSE and MRSA were 71.43% and 72.00%,respectively.The Staphylococci were more resistant to penicillin and erythromycin,but more sensitive to vancomycin and linezolid.Candida albicans was the major fungi in burn patients.CONCLUSION The gram-negative bacteria are still the predominant pathogens isolated from the burn patients,while the isolation rates of the gram-positive bacteria and fungi are increasing gradually.The drug resistance of the pathogens is so serious that it is crucial for the reasonable use of antibiotics to monitor the drug resistance of the pathogens in a timely manner.