烧伤患者创面菌群分布趋势及常用抗菌药物使用强度分析

Analysis of the wound flora distribution trend and antibiotics use density in patients with burn

目的分析我院烧伤患者创面菌群分布趋势、耐药性及基本抗菌药物使用情况,为临床经验用药以及合理用药提供依据。方法收集2010年1月-2013年12月天津市第一中心医院整形烧伤外科456例烧伤患者的创面分泌物标本,进行细菌培养。采用全自动微生物鉴定及药敏分析系统进行鉴定。采用K-B纸片扩散法,选择一、二代头孢及阿米卡星等22种临床常用抗菌药物进行药物敏感试验。统计每年我院头孢硫脒、亚胺培南等6种常用抗菌药物的每百住院日的规定日计量频数作为该药使用强度。统计各年份病原菌检出分布和主要菌群的耐药性情况。结果 2010-2013年,我院烧伤患者送检标本病原菌检出率波动于20%左右,在检出病原菌总数中所占比例居前5位的分别为铜绿假单胞菌（19.52%）、鲍曼不动杆菌（19.25%）、金黄色葡萄球菌（18.45%）、表皮葡萄球菌（12.30%）、阴沟肠杆菌（12.30%）。鲍曼不动杆菌整体检出率一直居高不下,金黄色葡萄球菌整体检出率有下降趋势。铜绿假单胞菌虽然2013年检出率稍有下降,但整体检出率呈上升趋势,且整体检出率已超过鲍曼不动杆菌位列第一。2010年起,金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌对一代和二代头孢类和林可霉素类等抗菌药物的耐药性呈上升趋势。2010年起,我院头孢硫脒、左氧氟沙星等常用抗菌药物使用强度略有上升,亚胺培南使用强度下降。结论我院2010-2013年烧伤患者病原菌阳性率较低,但细菌耐药性增强,可能与抗菌药物使用强度有关,应加强对烧伤患者早期的经验用药,以及抗菌药物的合理应用。

Objective To analyze the wound flora distribution trend, drug resistance and the antibiotics use in burn patients in our hospital, and provide a basis for the rational antibiotics use. Methods 56 wound flora secretion specimens of burn patients were collected from burn plastic surgical department of Tianjin First Central Hospital from Jan 2010 to Dee 2013. The bacteria was cultured and identified by using automatic microbial identification and drug susceptibility analysis system. 22 clinical common antibiotics use including amikaein, the first-and second-generation eepbalosporin were used for drug-sensitive test by means of K-B disk-diffusion method. Day dose per one hundred hospitalization days of 6 commonly used antibiotics such as cefatbiamidine and imipenem was used as antibiotics use density. Results From 2010 to 2013, the positive rate of sampies was about 20%. The top five detected pathogen was pseudomonas aeruginosa （19.52%）, acinetobacter baumannii （19.25%）, staphylococcus aureus （18.45%）, epidermis staphylococcus （12.30%）, and enterobacter cloacae （12.30%）, respectively. The detection rate of acinetobacter baumannii was high. Although the detection rate of pseudomonas aernginosa had slightly deceased in 2013, the overall detection rate had increased and was already higher than that of acinetobacter baumannii. Since 2010, the resistance of staphylococcus anreus, pseudomonas aeruginosa, acinetobacter banmannii to clindamycin, fisrt-and second-genera- tion cephalosporins had increased. At the same time, the use density of cefathiamidine, levofloxacin and other commonly used antimicrobial drug had slightly increased while that of imipenem had decreased. Conclusion The positive rate of pathogenic bacteria in burn patients of our hospital from 2010 to 2013 was low, but bacteria resistance had increased. This may be related to the use density of antibiotics. The empirical and rational use of antibiotics for early period burn patients should be strengthened.