伤口感染病原菌分布及耐药谱分析

Wound infection pathogens and drug resistance spectrum analysis

目的探讨创伤患者伤口感染的常见病原菌及其耐药性,指导临床合理用药。方法回顾分析2010年至2012年创伤患者感染伤口分泌物的细菌分离培养及体外药物敏感试验,对感染的主要病原菌及耐药性进行分析。结果分离到细菌1 086株,居于感染首位的是金黄色葡萄球菌(23.6%),其次是大肠埃希菌(23.2%),肺炎克雷伯菌(10.2%),鲍曼不动杆菌(8.8%),铜绿假单胞菌(6.6%),分离到8株白色假丝酵母菌(0.7%);耐甲氧西林金黄色葡萄球菌(meticillin_multiple resistance S.aureus,MRSA)检出率为71.5%,MRSA除对万古霉素、利奈唑胺100%敏感外,对其他常用抗菌药物均存在较高的耐药性,与MRSA的耐药性明显高于MSSA(P<0.01)。产超广谱β-内酰胺酶菌株(extended-spectrum beta-lactamase,ESBLs)的检出率为64.5%,除碳青霉烯类抗菌药物外,ESBLs对喹诺酮类、氨基糖甙类等的常用抗菌药物存在较高的耐药率;其耐药率远高于非ESBLs(P<0.01);多重耐药的铜绿假单胞菌(multi-drug resistant Pesudomonas aeruginosa,MDRPA)检出率为40.3%(29/72),耐碳青霉烯的鲍曼不动杆菌(Carbapenems-resistant Acinetobacter baumannii,CA-Ab)的检出率为43.2%(41/95)。仅头孢哌酮/舒巴坦及阿米卡星有良好的敏感性(>50%),而对其余绝大部分常用抗菌药物的耐药性相当严重。结论伤口感染以革兰阳性球菌为主,感染病原茵多为多重/泛耐药菌株,对常用抗菌药物甚至碳青霉烯类耐药性严重,应该引起高度重视,临床应据细菌药物敏感性试验报告选用抗菌药物。

bstract： Objective To explore the common pathogens and their resistance to trauma patients wound infection, guide rational clinical therapy. Methods Retrospective analysis of 2010 - 2012 trauma patients infected wound secretions bacteria were cultured and drug sensitivity test. The main pathogens and drug resistance were analyszed. Results Isolated the bacteria in 1 086 strain, living in the first place of infection was Staphylococcus aureus （ 23.6% ）, followed by Escherichia coli （ 23. 2% ） , Klebsiella pneumonia （ 10. 2% ）, Acinetobacter baumanni （8.8%） ,Pseudomonas aeruginosa（ 6.6% ） ,isolated eight Candida albieans （0.7%） ; Methicillin-resistant Staphy- lococcus aureus （ meticillin-muhiple resistance S. aureus, MRSA） 71.5%. Main infected with Staphylococcus au- reus was a moreserious resistanee to other commonly used antibiotics except vancomyein, linezolid 100% sensitive. With MRSA resistance was significantly higher than MSSA （ P 〈 0.01 ）. Enterbacteriaceae produeing extended speetrum [3-]actamase strains （ESBL） detection rate was 64.5%. The ESBLs resistance than non-producing strains serious（P 〈0.01 ）. To quinolones, aminoglyeosides eommonly used in high resistanee rates. Muhi-drug resistant Pseudomonas aeruginosa （MDRPA） detection rate of 40.3 % , Carbapenem-resistant Acinetobaeter baumannii detec- tion （CA-Ab） rate of 43.2%. Only cefoperazone/sulbaetam and amikacin had good sensitivity（ 〉 50% ） ,while a majority of antimicrobial resistance is quite serious. Conclusion Wound infection pathogens are gram-positive bacteria. The infectious pathogens were muhipart/pan-resistant strains, and serious resistance to commonly used antibiotics, the clinical use of antimierobial drugs based on culture results and drug sensitivity test report.