骨科患者伤口分泌物病原菌分布及药敏277例分析

Analysis on 277 Cases of Orthopaedics Patients' Wound Secreta Pathogenic Bacteria Distribution and Drug Allergy

[目的]分析骨科患者伤口分泌物病原菌分布及药敏试验,为骨科临床医生合理治疗及控制医院感染提供依据。[方法]将2009年1月至2013年12月我院277例门诊和住院骨科患者的伤口分泌物标本接种于血平板、巧克力平板,按《全国临床检验操作规程》3版要求分离纯菌,用法国生物梅里埃公司API鉴定和K-B法做药敏试验。[结果]185株伤口分泌物病原菌中检出前5位的病原菌是阴沟肠杆菌36株占19.5%,金黄色葡萄球菌32株占17.3%,表皮葡萄球菌29株占15.7%,大肠埃希菌26株占14.1%,铜绿假单胞菌20株占10.8%。大肠埃希菌26株,产ESBLs阳性占26.9%(7/26株),主要革兰阴性杆菌对氨苄西林和头孢唑林的耐药率最高;未发现革兰氏阴性杆菌对头孢哌酮/舒巴坦和亚胺培南耐药。耐甲氧西林金黄色葡萄球菌检出率为21.9%,耐甲氧西林表皮葡萄球菌检出率为20.7%,且对青霉素的耐药率较高,未发现耐万古霉素的葡萄球菌。[结论]阴沟肠杆菌和金黄色葡萄球菌是创伤患者伤口优势菌种,而且细菌耐药性高;临床医生应合理制定治疗方案,选择使用有效的抗菌药物。

[Objective] To analyse the orthopaedics patients＇ wound secreta pathogenic bacteria distribution and drug allergy test, and offer foundation for clinical orthopaedics doctors＇ reasonable treatment and controlling hospital infection. [Method] Make inoculation of the wound secreta sample on the blood plate and chocolate plate, separate the pure bacteria under ＂National Clinical Test Operational Rules＂ of 3d issue, and make drug allergy with French BioMerieux AP1 Authentication and K-B method. [Result] The first 5 pathogenic bacteria detected in 189 strains of wound secreta are： 36 strains of enterobacter cloacae, occupying 19.5%; 32 strains of staphylococcus aureus, occupying 17.3%; 29 strains of staphylococcus epiderrrfidis, 15.7%; 26 strains of Escheric hia coli, 14.1%; 20 strains of pseudomonas aeruginosa, 10.8%; the 26 strains of Escherichia cob have positive E SBLs 26.9%（7/26strains）; the gram negative bacilli has highest drug resistance rates to ampicillin and cefazolin, without resistance to cefoperazone/sulbactam and imipenem. The detection rate is 21.9% for methoicillin-resistant staphylococcus epidermidis; the detection rate of methiciUin-resistant staphylococcus epeidermJdis is 20.7%,with highest resistant rate to penicillin, without staphylococcus resisting vancomycin. [Conclusion] The enterobacter cloacae and staphylococcus are the advantageous bacteria of wounds, with high drug resistance; the clinical doctors shall reasonably make out treatment plan and select effective anti-bacterial drugs.