骨科创伤患者感染病原学分布与耐药性分析

Etiological distribution and drug resistance in orthopedic trauma patients with infections

目的分析骨科创伤患者感染病原菌的分布及药物敏感性,为临床治疗骨科创伤感染患者合理用药及减少耐药菌产生提供参考依据。方法对2011年6月至2014年8月骨科创伤感染患者临床标本中检出的病原菌监测资料作回顾性分析,采用纸片扩散法检测药物敏感性。结果 590株骨科创伤患者感染病原菌中,以伤口及创面感染分离率较高,各检出299株、122株,分别占50.68%、20.68%;其中革兰阳性菌244株,占41.36%,革兰阴性菌327株,占55.42%,真菌19株,占3.22%;主要革兰阳性菌对万古霉素、替考拉宁、米诺环素、利奈唑胺,主要革兰阴性菌对阿米卡星、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南敏感度较高外,对大多数常用的抗菌药物的耐药率均较高。结论骨科创伤患者感染以伤口和创面感染多见,感染病原菌以革兰阴性菌为主,主要革兰阳性及阴性菌耐药率均较高,应引起临床医师高度重视,加强医院感染防控,合理使用抗菌药物,提高患者免疫力,减少骨科创伤患者的感染与耐药产生。

Objective To analyze the distribution and drug sensitivity of pathogens from orthopedic trauma patients with infections and provide reference for rational use of drugs. Methods The pathogens detected from the clinical specimens of orthopedic trauma patients during June 2011 and August 2014 were retrospectively analyzed. Disk diffusion assay was performed to determine the drug sensitivity. Results Of the total 590 pathogens detected in the patients,most were from incisions（ 299 strains,50. 68%） and wounds（ 122 strains,20. 68%）,including 244Gram-positive bacteria（ 41. 36%）,327 Gram-negative bacteria（ 55. 42%） and 19 fungi（ 3. 22%）. The main Gram-positive bacteria were sensitive to vancomycin,teicoplanin,minocycline and linezolid,while the main Gramnegative bacteria were sensitive to amikacin,meropenem,piperacillin / tazobactam,cefoperazone / sulbactam and imipenem. Their resistance to other most commonly used antimicrobials were high. Conclusion Orthopedic trauma patients can often get infection in the incisions and / or wounds mainly by Gram-negative and Gram-positive bacteria with high resistance to antibacterial drugs,which should be highly attended. The prevention and control of the infections should be strengthened and antimicrobial drugs should be used rationally to increase the patients＇ immunity and lower the infection rate and drug resistance.