烧伤患者创面病原菌分布及耐药性分析

Distribution and drug resistance of pathogens isolated from wound of burn patients

目的调查烧伤患者创面病原菌的分布及抗菌药物的耐药性,以便指导临床合理使用抗菌药物。方法对2010年5月-2012年5月烧伤患者创面培养分离的病原菌采用法国生物梅里埃公司ATB Expression半自动细菌鉴定仪,按照《全国临床检验操作规程》进行细菌鉴定,采用K-B法进行药敏试验,按照2010年版CLSI标准判断结果;所有数据用WHONET5.6软件进行统计分析。结果共分离烧伤创面病原菌310株,革兰阳性菌204株占65.8%,以表皮葡萄球菌、溶血葡萄球菌、屎肠球菌、金黄色葡萄球菌为主,分别占19.7%、13.2%、8.4%、8.1%,革兰阳性菌对万古霉素、利奈唑胺、替考拉宁均100.0%敏感;检出革兰阴性菌106株占34.2%,以鲍氏不动杆菌、铜绿假单胞菌、阴沟肠杆菌、肺炎克雷伯菌为主,分别占8.7%、7.1%、3.9%、3.5%,其中泛耐药鲍氏不动杆菌占81.5%,耐碳青霉烯类铜绿假单胞菌占9.1%,肠杆菌科细菌对碳青霉烯类抗菌药物100.0%敏感。结论应加强烧伤创面病原菌的监测,为临床合理使用抗菌药物和严格执行消毒隔离措施提供参考依据。

OBJECTIVE To investigate the distribution and drug resistance of pathogens isolated from wounds of burn patients so as to provide guidance for reasonable clinical use of antibiotics. METHODS From May 2010 to May 2012, the pathogens cultured from the wounds of the burn patients were identified by using the ATB Expression semi-automatic bacteria identification system of BioM6rieux, France, the bacterial identification was carried out according to the National clinical laboratory operation guidelines, the drug susceptibility testing was performed with the use of K-B method, the results were determined according to the CLSI criteria of 2010 edition, and all the data were statistically analyzed by using the WHONET5.6 software. RESULTS A total of 310 strains of pathogens have been isolated from the wounds of the burn patients, including 204 （65.8 %） strains of gram-positive bacteria and 106 （34.2%） strains of gram-negative bacteria; the Staphylococcus epidermidis, Staphylococcus hemolytic, Enterococcus faecalis, and Staphylococcus aureus were the predominant species of gram-positive bacteria, accounting for 19.7%, 13.2%, 8. 4%, and 8. 1%, respectively; the Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae, and Klebsiella pneumoniae were dominant among the gram-negative bacteria, accounting for 8.7%, 7.1%, 3.9%, and 3.5 %, respectively; the pandrug-resistant A. baumannii accounted for 81.5%, and the carbapenem-resistant P. aeruginosa accounted for 9.1%. The drug susceptibility rates of the gram-positive bacteria to vancomycin, linezolid, and teicoplanin were 100.0 % ; the drug susceptibility rates of the Enterobacteriaceae to carbapenems were 100.0%. CONCLUSION It is necessary to strengthen the surveillance of the pathogens isolated from the wounds of the burn patients so as to provide guidance for reasonable clinical use of antibiotics and strict implementation of disinfection and isolation measures.