前臂开放性创伤患者病原菌分布及耐药性分析

Distribution and drug resistance of pathogens in patients with forearm open trauma

目的探讨前臂开放性创伤患者的病原菌分布和耐药性,为临床中合理地指导抗菌药物使用提供参考。方法将2009年2月-2010年2月120例开放性手及前臂创伤感染的患者伤口分泌物进行细菌培养,并进行药敏试验的分析。结果通过细菌的培养鉴定,共分离出142株病原菌,主要有金黄色葡萄球菌、表皮葡萄球菌、肠球菌属、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌等,分别占22.5%、12.7%、7.0%、25.4%、17.0%、7.7%、7.7%;革兰阳性菌中金黄色葡萄球菌、表皮葡萄球菌、肠球菌属对青霉素类的抗菌药物的耐药率分别为90.6%、94.4%、90.0%;革兰阴性菌中大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌对青霉素类抗菌药物的耐药率分别为86.1%、87.5%、81.8%、81.8%;革兰阳性菌对万古霉素的耐药性最低,革兰阴性细菌对亚胺培南的耐药性最低。结论开放性手及前臂创伤患者发生感染比较常见,而且病原菌的分布也比较广泛,对病原菌耐药性有效地监测,能正确地指导患者用药。

OBJECTIVE To discuss the distribution and drug resistance of pathogens in the forearm open trauma patients so as to reasonably use antibiotics.METHODS A total of 120cases of patients with forearm open trauma infections,who were treated in the hospital fro Feb 2009to Feb 2010,were enrolled in the study,then the wound secretions were collected for the bacterial culture,and the drug susceptibility testing was performed.RESULTS Through the bacterial culture and identification,totally 142strains of pathogens were isolated,among which the Staphylococcus aureus accounted for 22.5%,Staphylococcus epidermidis 12.7%,Enterococcus 7.0%,Escherichia coli 25.4%,Pseudomonas aeruginosa 17.0%,Klebsiella pneumoniae 7.7%,and Acinetobacter baumannii 7.7%.Among the gram-positive bacteria,the drug resistance rates of the Staphylococcus aureus,Staphylococcus epidermidis,and Enterococcus to penicillins were 90.6%,94.4%,and 90.0%,respectively;among the gramnegative bacteria,the drug resistance rates of the Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,and Acinetobacter baumannii to penicillins were 86.1%,87.5%,81.8%,and 81.8%,respectively;the drug resistance rate of the gram-positive bacteria to vancomycin was the lowest,and the drug resistance rate of the gram-negative bacteria to imipenem was the lowest.CONCLUSION The infections are common seen in the open hand and forearm trauma patients,and the pathogens are widely distributed;the effective monitoring of drug resistance can guide the reasonable use of antibiotics.