手外科患者伤口分泌物的病原菌分布及耐药性分析

Pathogenic bacteria distribution and antibiotic resistance analysis of hand surgery patients wound secretion

目的：对本院手外科患者伤口分泌物中病原菌的分布及其耐药性进行研究分析，为临床用药提供有利依据。方法对2012年1月—2013年5月本院手外科患者伤口分泌物的病原菌进行鉴定及药敏检测。结果本组823份伤口分泌物标本中分离培养出致病菌542份，阳性率为66%，共检测出致病菌株602株，其中包括一份标本有两种以上致病菌株。其中革兰氏阴性杆菌374株，占62%，革兰氏阳性球菌187株，占31%，真菌41株，占7%。革兰氏阴性杆菌前几位为大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌；革兰氏阳性球菌以金黄色葡萄球菌为主。45%的大肠埃希菌产超广谱β-内酰胺酶（ESBLs），对很多抗生素耐药。28%的金黄色葡萄球菌为耐甲氧西林菌株，没有耐万古霉素的金黄色葡萄球菌株。结论本院手外科患者伤口分泌物标本中以革兰氏阴性杆菌为主，耐药问题比较严重，应对抗生素的合理应用给予足够的重视。

Objective To analyse the pathogenic bacteria distribution and antibiotic resistance of hand surgery patients wound secreta, and offer basis for clinical hand surgery doctors reasonable treatment. Methods Disk diffusion test（k-B test） and DL-96 assay system was used to detect the pathogenic bacteria and to analyse antibiotic resistance. Results The pathogenic bacteria in 542 cases were isolated from 823 cases wound secretion, the positive rate was 60%. And 602 plants pathogenic bacteria were examined, including over two kinds of pathogenic bacteria in a sample. Gram negative bacteria were 374 （62%）, gram positive bacteria were 187 cases（31%）, fungus were 41 cases（7%）. The most detected gram negative bacteria were escherichia coli pseudomonas aeruginosa, acinetobacter baumannii, enterobacter cloacae. The most detected gram positive cocci was staphylococcus aureus. The 64 strains of escherichia coli had positive ESBLS 45%（64/143 strains）. The detection rate was 28% for methoicillin -resistant staphylococcus epidermidis. Without staphylococcus resisting vancomycin. Conclusion Gram negative bacteria is the main pathogenic bacteria in hand surgery patients wound secretion, the antibiotic resistance is relatively serious, it should be enough attention to use antibiotic possibly.