骨伤科混合感染菌群的分布及耐药特征

THE DISTRIBUTION AND DRUG-FAST CHARACTERISTICS OF FLORA OF MIXED INFECTIONS IN ORTHOPEDICS AND TRAUMATOLOGY

为了指导骨伤科混合感染的治疗 ,统计分析了 77例混合感染患者的临床资料、菌种鉴定和药敏试验结果 ,并与同期单菌种感染菌株的耐药性进行了比较。结果表明 ,开放性骨折、慢性骨髓炎易发生混合感染 ,分别占混合感染病例的 42 .86 %和 2 0 .78%。条件致病菌参与混合感染较为普遍 ,铜绿假单胞菌、大肠埃希氏菌与其他菌种混合感染占 5 0 .6 4%和 2 5 .87% ,说明感染类型正在发生变化。混合感染组合菌株对 16种常用抗生素耐药率超过 5 0 %的达 10种 ,有 12种较同期单菌种感染菌株的耐药率高10～ 30 % ,而且多重耐药和不对称耐药现象较为严重 ,用药个体化非常重要。混合药敏试验 ,有利于混合感染治疗的抗生素选择 。

In order to instruct the treatment of mixed infection in orthopedics and traumatology, the clinical data and the results of the drug sensitive tests and bacterial type identification of 77 cases with mixed infection were estimated and analysed and also compared with the drug resistance of the homochronous monoinfective strains. The results showed that open fractures and chronic osteomyelitis tended to have mixed infection with 42.86 % and 20.78 % of the cases of mixed infection respectively. It was quite common that the opportunistic pathogens participated in mixed infection. The mixed infections from verdigris pseudomonas, Escherichia coli and other pathogens were 50.64 % and 25.87 %, suggesting that the types of infections were changing. Of the combined strains of mixed infection, 10 strains had more than 50 % of a drug resistance rate to 16 common antibiotics and 12 strains had a drug resisting rate 10 % to 30 % higher than monoinfective strains and severe multiple and asymmetric drug resistances. So the individualization in the drug application is very important. The mixed drug sensitive tests benefit the selection of antibiotics for mixed infection, and effectively avoid or decrease the combined application of antibiotics.