胫腓骨开放性骨折患者创口病原菌感染的耐药性分析

Drug resistance of pathogenic bacteria causing incisional wound infections in patients with open fractures of tibia and fibula

目的探讨医院骨折患者创口感染的病原菌分布及耐药性,为临床抗感染治疗提供依据。方法回顾性调查169例胫腓骨开放性骨折外固定后,手术患者创口感染标本的检测分离的菌株耐药性分析及抗菌药物的临床应用特点。结果培养出病原菌169株,以金黄色葡萄球菌为主,分离出耐甲氧西林金黄色葡萄球菌(MRSA)17株,占33.33%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)3株,占25.00%,对万古霉素、替考拉丁、呋喃妥因最为敏感;大肠埃希菌产ESBLs菌13株,占31.71%;铜绿假单胞菌产ESBLs菌5株,占45.45%;亚胺培南、美罗培南、妥布霉素、哌拉西林/他唑巴坦仍具有很好抗菌作用。结论胫腓骨开放性骨折,要注重创口的无菌性清创处理,耐药菌株应严格监测和控制,合理使用抗菌药物,降低创面感染率,提高临床的治愈率。

OBJECTIVE To investigate the distribution and resistance of pathogenic bacteria causing wound infections in the fracture patients so as to guide the clinical anti-infection tt^erapy. METHODS A total of 169 cases of patients with open fractures of tibia and fibula were retrospectively investigated after the external fixation, the drug resistance of the strains isolated from the wound infection specimens was analyzed, and the clinical character- istics of the use of antibiotics were observed. RESULTS Totally 169 strains of pathogenic bacteria were isolated, among which Staphylococcus aureus was dominant, there were 17 （33. 33%） strains of methicillin-resistant S. aureus （MRSA） and 3 （25.00%） strains of methicillin-resistant coagulase-negative Staphylococci （MRCNS）. The strains were most sensitive to vancomycin, teieoplanin and furadantin~ there were 13 （31.71%） strains of ESBLs-producing Escherichia coli and 5 （45. 45%） strains of ESBLs-producing Pseudomonas aeruginosa. Imipenem, meropenem, tobramycin and piperacillin /tazobactam still had good antibacterial activity. CONCLUSION For the patients with open fractures of tibia and fibula, it is necessary to focus on the aseptic debridement, strictly monitor and control the drug resistant strains, and reasonably use antibiotics so as to reduce the incidence of wound infections and improve the cure rate.