开放性骨折患者清创前后创面病原学培养及耐药性

Pathogenic culture and detection of antimicrobial resistance of pathogens before and after debridement in patients with open fractures

目的了解开放性骨折患者伤口分泌物病原菌检出情况及其耐药性,以指导临床治疗。方法对某院2012年5月—2013年7月1 472例开放性骨折患者清创前后伤口分泌物标本进行病原菌培养和鉴定,以及药敏试验。结果清创前,1 472例患者的分泌物标本中,1 246例(84.65%)培养阳性,共检出病原菌2 246株,其中824例(55.98%)检出2种及以上菌株。实施清创术后8 h,195例(13.25%)患者标本培养阳性,检出病原菌201株。Gustilo分型中,伤情越严重者病原培养阳性率越高。创面培养阳性率,清创前各分型患者均>50%;清创后,Ⅰ型、Ⅱ型与ⅢA型患者均<5%,而ⅢB和ⅢC型患者仍较高。金黄色葡萄球菌、表皮葡萄球菌对万古霉素敏感,对呋喃妥因耐药率<5%,对青霉素G、红霉素高度耐药(耐药率>75%);鲍曼不动杆菌对多种抗菌药物具有较强的耐药性,即使较为敏感的头孢哌酮/舒巴坦耐药率也达20%;铜绿假单胞菌对亚胺培南耐药率为10.80%,对头孢哌酮/舒巴坦、头孢吡肟、头孢他啶也较为敏感。结论对开放性骨折患者及时清创能明显减少创面病原菌;病原菌的药敏试验结果有助于指导临床合理用药。

Objective To realize the detection of pathogens and antimicrobial resistance of pathogens isolated from wound secretion in patients with open fractures,so as to guide clinical treatment.Methods 1 472 patients with open fractures from May 2012 to July 2013 were selected from a hospital,pathogens from wound secretions before and after debridement were identified and performed antimicrobial susceptibility testing.Results Before debridement,1 246 of 1 472 patients（84.65%）were isolated2 246 bacterial strains,824（55.98%）of patients were isolated at least 2 kinds of bacteria.Eight hours after debridement,201 pathogenic bacteria were isolated from195 patients（13.25%）.The more serious of Gustilo type,the higher the positive rate of bacterial culture.Positive rate of wound culture were all50%in patients of all Gustilo types before debridement;positive rate were all〈5%in patients of type Ⅰ,Ⅱ and ⅢA,but typeⅢ B and ⅢC were still high after debridement.Staphylococcus aureus and Staphylococcus epidermidis were sensitive to vancomycin,the resistant rates to furantoin were〈5%,the resistant rates to penicillin G and erythromycin were all〉75%.Acinetobacter baumannii had higher resistance to multiple antimicrobial agents,to cefoperazone/sulbactam was 20%;Pseudomonas aeruginosa to imipenem was 10.80%,sensitivity to cefoperazone/sulbactam,cefepime and ceftazidime were all higher.Conclusion For patients with open fractures,timely debridement can reduce wound pathogen,antimicrobial susceptibility testing result is helpful for guiding rational antimicrobial use.