烧伤患者常见病原菌及其抗菌药物敏感性分析

Analysis on common pathogens in burn patients and their drug susceptibility

目的了解解放军第一一八医院烧伤患者临床分离病原菌的分布及其药物敏感性。方法通过自行创建的细菌耐药监测预警系统提取2011年1月至2013年12月烧伤救治中心住院患者的441株临床分离病原菌的细菌培养及药敏试验结果,进行整理、分析和总结。结果在临床分离出的441株病原菌中,革兰阴性菌251株,占56.92%;革兰阳性菌99株,占22.45%;真菌91株,占20.63%。白色念珠菌对两性霉素B和5-氟胞嘧啶的敏感率均为100.00%;表皮葡萄球菌、溶血葡萄球菌和金黄色葡萄球菌3种主要革兰阳性菌对万古霉素的敏感率均为100.00%;肺炎克雷伯菌对亚胺培南及美罗培南的敏感率均为94.87%,奇异变形杆菌对亚胺培南的敏感率高达100.00%,大肠埃希菌对美罗培南的敏感率也高达91.90%。但在鲍曼不动杆菌和阴沟肠杆菌对抗菌药物的敏感性较差,仅对阿米卡星较敏感,敏感率分别为77.78%和88.57%。结论烧伤患者以革兰阴性菌感染为主,真菌感染有上升的趋势,细菌耐药情况严重,需充分利用检验科细菌耐药预警监测系统,合理使用抗菌药物,加强烧伤初期的保护性治疗及护理,完善严格的消毒和隔离措施。

Objective To understand the isolated pathogen distribution and the drug susceptibility among the burn patients in 118 hospital of PLA.Methods The bacterial culture and drug susceptibility test results in 441 strains of pathogen clinically isolated from the inpatients in the Burn Save and Cure Center from Jan.2011 to Dec.2013 were extracted by the self-established bacterial drug resistance monitoring and early warning system and performed the data collation,analysis and summary.Results Among 441 strains of clinically isolated pathogen,251 strains were Gram-negative bacteria,accounting for 56.92%;99strains were Gram-positive bacteria,accounting for22.45%;91strains were fungi,accounting for 20.63%.The sensitivity of Candida albicans to amphotericin B and 5-fluorocytosine was 100.00%;the sensitivity of 3kinds of main Gram-positive bacteria of Staphylococcus epidermidis,Staphylococcus and hemolytic aureus to vancomycin was 100.00%;the susceptibility rates of Klebsiella pneumoniae to imipenem and meropenem were 94.87%;the susceptibility rate of Proteus mirabilis to imipenem reached up to100.00% and which of Escherichia coli to meropenem also reached 91.90%.However,Acinetobacter baumanii and Enterobacter cloacae had poorer susceptibility to antibacterial drugs,were sensitive only to amikacin,the susceptibility rates were 77.78%and 88.57%respectively.Conclusion The Gram-negative bacterial infection is predominant among the burn patients in our hospital,the fungal infection shows an upward trend.The Bacterial drug resistance is serious.It is needed to fully play the bacterial drug resistance monitoring and early warning system in the laboratory department,rationally use the antibacterial drugs,strengthen the protective treatment and nursing in the early stage of burn and perfect the strict disinfection and isolation measures.