四肢创伤患者感染病原菌分析及预防对策

Analysis about Limb trauma patients infected with pathogens and prevention countermeasures

目的探讨分析四肢创伤患者感染病原菌分布及其药敏情况,并提出相应的预防对策,以期为控制感染提供可靠依据。方法采用回顾性与前瞻性研究方法对医院2009年1月-2012年12月收治的四肢创伤患者感染病原菌监测资料和药物敏感性进行分析;采用SPSS19.0软件进行统计分析,计数资料采用χ2检验。结果感染部位以呼吸道、伤口、泌尿道、血液为主,分别占35.71%、25.00%、17.86%、12.50%;共分离出54株病原菌,其中革兰阴性菌31株占57.41%;革兰阳性菌19株占35.18%;真菌4株占7.41%,排前5位病原菌依次为铜绿假单胞菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌,分别占25.93%、16.67%、14.81%、12.96%、11.11%;主要革兰阴性菌对亚胺培南、头孢哌酮和头孢他啶高度敏感,主要革兰阳性菌对万古霉素、磺胺甲噁唑/甲氧苄啶和替考拉宁高度敏感。结论四肢创伤患者感染的病原菌分布以革兰阴性菌为主,应加强环境中病原菌监测,及时了解病原菌对抗菌药物的敏感性,合理选用抗菌药物,采取积极的预防对策,降低患者医院感染的发生。

OBJECTIVE To explore and analyze the pathogen distribution and susceptibility for limb trauma patients with infections,and propose appropriate preventive measures in order to provide a reliable basis for the control of infections.METHODS The method of retrospective and prospective studies were adopted for analyzing the drug sensitivity and monitoring data of pathogenic bacteria for the limbs trauma patients with infections and accepted in our hospital during Jan.2009-Dec.2012.SPSS19.0software was used for statistical analysis and X2test was used for data collection.RESULTS The main infection sites were respiratory tract,wound,urinary tract and blood,accounting for 35.71%,25.00%,17.86%and 12.50%.A total of 54strains of pathogenic bacteria were isolated, among which gram-negative bacteria were 31strains,accounting for 57.41%,19strains of gram-positive bacteria, accounting for 35.18%,4strains of fungi,accounting for 7.41%.The top five pathogenic bacteria were Pseudomonas aeruginosa,Staphylococcus aureus,Coagulase negative Staphylococcus,E.coli and Klebsiella pneumoniae,accounting for 25.93%,16.67%,14.81%,12.96% and 11.11%;The main gram-negative bacteria to imipenem,cefoperazone and cephalosporin were highly sensitive,and gram-positive bacterium to vancomycin,sulfamethoxazole/trimethoprim and teicoplanin were highly sensitive.CONCLUSION Limb trauma patients infected mostly by gram-negative bacteria.Pathogens should be under monitoring and the sensitivity of pathogens to antimicrobial drugs should be understood timely with rational use of antimicrobial drugs and active preventive measures in order to reduce the incidence of nosocomial infection in patients.