我院骨科2011-2013年住院患者感染的病原菌分布及耐药性分析

Analysis of Distribution and Drug Resistance of Pathogens in the Infection Inpatients from Orthopedic Department of Our Hospital during 2011-2013

目的:了解我院骨科住院患者感染的病原菌分布及其耐药性变化,为临床合理用药提供参考。方法:调查2011-2013年我院骨科住院患者分泌物、脓液及关节腔穿刺液等230份骨科标本的细菌培养结果,对其药敏试验结果进行分析。结果:230份骨科标本中,阳性标本157份,阳性率68.3%;阳性标本共分离到各种病原菌165株,其中革兰阳性菌占51.5%,革兰阴性菌占48.5%。金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌和凝固酶阴性葡萄球菌是引起骨科感染的主要病原菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为28.6%和78.6%;产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和阴沟肠杆菌的检出率分别为64.7%和33.3%。葡萄球菌对万古霉素100%敏感;肠杆菌科细菌对哌拉西林/他唑巴坦、阿米卡星及碳青霉烯类药物具有较高的敏感性;铜绿假单胞菌对多数试敏药的耐药率低于20%。结论:我院骨科感染的病原菌分布较为广泛,主要以葡萄球菌为主。近几年苯唑西林耐药菌株的增多及革兰阴性杆菌不断上升,提示临床对骨科感染的治疗,应结合患者感染的诊断、基础疾病及本院细菌培养数据选择抗菌药物,并应重视细菌培养。

OBJECTIVE： To explore the distribution and drug resistance of pathogen in the infection patients from orthopedics department of our hospital, and to provide reference for rational drug use in the clinic. METHODS ： The culture of pathogens from 230 specimens included wound secretion, pus, joint cavity puncture fluid and so on, and the result of the drug susceptibility testing from department of orthopedics in recent 3 years were retrospectively analyzed. RESULTS： Of total 230 test samples in orthopedics department, there were 157 positive samples with positive rate of 68.3%. 165 strains of pathogenic bacteria were isolated from the positive specimens, among which Gram-positive bacteria accounted for 51.5% and Gram-negative bacteria accounted for 48.5%. The main pathogens were Staphylococcus aureus, Escherchia coli, Pseudomonas aeruginosa, Enterobacter cloacae and coagulase negative staphylococcus.The detection rates of MRSA and MRCNS were 28.6% and 78.6%, and the detection rates of extend- ed-spectrum β-lactarnase-producing （ESBLs） E.coli and E. cloacae were 64.7% and 33.3%. The staphylococcus was sensitive to vancomycin completely; Enterobacteriaceae was highly sensitive to piperacillin/tazobactam, amikacin and carbopenems; drug resis- tance rate of P aeruginosa was lower than 20%. CONCLUSIONS： Various strains pathogenic bacteria were isolated from infective samples in orthopedics department, and staphylococci are the main pathogenic bacteria in surgical infection. Oxacillin-resistant strains and Gram-negative bacillus increased in recent years, which indicated in the anti-infective therapy in orthopedics depart- ment, the antibiotics should be chosen on the basis of the diagnosis of infection, underlying diseases and the data of bacterial cul- ture in the hospital. Moreover, the culture of pathogens should be given attention.