1006例创伤感染患者伤口1257株细菌耐药监测

Surveillance of bacterial antibiotic resistance in traumatic wound infection： a report of 1006 cases

目的监测创伤感染患者伤口致病菌分布及时抗生素的敏感性，为临床合理应用抗生素提供依据。方法细菌鉴定采用表型鉴定，极少数菌采用分子生物学鉴定。药敏试验采用最小抑菌浓度（mininmm inhibitory concentration，MIC）微量稀释法或Kirby—Bauer纸片扩散法。结果1006例患者共检出121种1257株致病菌，前10位菌占70．09％。革兰阳性球菌占48．93％，革兰阴性杆菌占49．72％。在金黄色葡萄球菌和表皮葡萄球菌中耐甲氧西林的菌株分别占34．76％和71．08％；未检出对万古霉素、利奈唑胺耐药的金黄色葡萄球菌和表皮葡萄球菌。在粪肠球菌中耐万古霉素肠球菌（vancomycin resistantent erococcal，VRE）检出率为6．06％，敏感率〉90％的抗生素依次为替考拉宁、氨苄青霉素及万古霉素。在屎肠球菌中VRE检出率为10．53％，替考拉宁敏感率〉90％，万古霉素敏感率〉80％。多重耐药鲍曼不动杆菌检出率为12．77％，敏感率〉70％的依次为亚胺培南、美罗培南。多重耐药鲍曼醋酸钙复合不动杆菌检出率为29．72％，敏感率〉50％的依次为亚胺培南、美罗培南。多重耐药铜绿假单胞菌检出率为3．73％，敏感率〉90％的依次为阿米卡星、美罗培南、亚胺培南及哌拉西林／他唑巴坦。未检出耐亚胺培南、美罗培南的大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌。大肠埃希菌中产超广谱β-内酰胺酶（extended-spectrum β-lactamases，ESBLs）菌株检出率为69．51％，哌拉西林／他唑巴坦敏感率〉90％，阿米卡星敏感率〉80％。肺炎克雷伯菌中产ESBLs株检出率为53．13％，阿米卡星敏感率〉80％。结论创伤感染以常见菌为主，粪肠球菌和屎肠球菌均对替考拉宁敏感性最高；两种不动杆菌均对亚胺培南具有最高敏感性。

Objective To monitor the distribution of pathogenic bacteria causing wound infection in trauma patients and their susceptibility to antibiotics in an effort to offer evidence for the rational clini- cal use of antibiotics. Methods Pathogens were identified by expressive type, but a very few was de- temlined by the molecular methods. Micro-dilution or Kirby-Bauer inethod for minimum inhibitory concen- tration （MIC） was adopted for drug susceptibility test. Results A total of 121 species of pathogens numbering 1,257 bacterial strains were isolated from 1,066 patients. Strain number of the top 10 species accounted for 70. 09%. Gram-positive cocci accounted for 48. 93% and Gram-negative bacilli for 49.72%. Among Staphylococcus aureus and epidermidis, methicillin-resistant bacterial strains accounted for 34.76% and 71.08% respectively, but none were resistant to vancomycin or linezolid. Enterococcus faecalis contained 6.06% vancomycin-resistant enterococcal （VRE） and remained 〉90% sensitive to teicoplanin, ampicilin and vancomycin. Enterococcus faecium contained 10.53% VRE and remained 〉 90% sensitive to teicoplanin and 〉 80% sensitive to vancomycin. Baumanii contained 12.77% multi- drug resistant strains and remained 〉70% sensitive to imipenem and meropenem. Baumanii/calcoacetic- us complex contained 29.72% multi-drug resistant strains and remained 〉 50% sensitive to imipenem and meropenem. Pseudomonas aeruginosa contained 3.73% multi-drug resistant strains and remained 〉 90% sensitive to amikacin, meropenem, imipenem and piperacillin/tazobactam. No E. coli, klebsiellapneumoniae and enterobacter cloacae resistant to imipenem or meropenem were found. E. coli contained 69.51% extended-spectrum β-1actamases （ESBLs） -producing strains and remained 〉 90% sensitive to piperacillin/tazobactam and 〉 80% sensitive to amikacin. Klebsiella pneumoniae contained 53.13% ES- BLs -producing strains and remained 〉 80% sensitive to amikacin. Conclusions Common bacteria are the leading cause of posttraumatic infection. Enterococcus faecalis and enterococcus faecium demonstrate higher susceptibility to teicoplanin; two kinds of acinetobacter demonstrate higher susceptibility to imipen- era.