开放性骨折患者感染病原菌分布与药敏分析

Distribution and drug susceptibility of pathogens causing infections in open fracture patients

目的观察和分析开放性骨折感染患者的病原菌分布和药敏情况,为临床合理用药提供依据。方法收集医院2010年1月-2013年12月收治的200例开放性骨折患者伤口感染分泌物标本,对采集标本进行细菌培养,并对分离出的病原菌进行菌种鉴定和药敏试验,采用K-B法进行药敏试验。结果 328份伤口分泌物标本中共分离出210株病原菌,检出率为64.02%;检出革兰阳性菌98株,占46.67%,其中以粪肠球菌、金黄色葡萄球菌和表皮葡萄球菌的检出最高,分别占16.19%、14.29%和11.43%;检出革兰阴性菌112株占53.33%,以铜绿假单胞菌和鲍氏不动杆菌的检出最高,分别占15.71%和13.81%;革兰阳性菌和革兰阴性菌对常用抗菌药物的耐药率均呈现上升的趋势。结论开放性骨折感染患者的病原菌呈现多种条件致病菌感染,病原菌的耐药率有所上升,应严格控制患者并发感染的高危因素,做好围手术期的预防感染工作,促进伤口尽快愈合,要及早进行伤口分泌物的细菌培养和药敏试验,根据试验结果合理选择抗菌药物。

OBJECTIVE To observe the distribution and drug susceptibility of pathogens causing infections in the open fracture patients so as to provide guidance for reasonable clinical use of antibiotics .METHODS The wound se‐cretion specimens were collected from 200 open fracture patients with infections who were treated in the hospital from Jan 2010 to Dec 2013 ,then the bacterial culture was carried out ,the isolated pathogens were identified ,and the drug susceptibility testing was performed by using K‐B method .RESULTS A total of 210 strains of pathogens have been isolated from 328 wound secretion specimens with the isolation rate of 64 .02% ,including 98 （46 .67% ） strains of gram‐positive bacteria and 112 （53 .33% ） strains of gram‐negative bacteria;the Enterococcus f aecalis , Staphylococcus aureus ,and Staphylococcus epidermidis were dominant among the gram‐positive bacteria ,ac‐counting for 16 .19% ,14 .29% ,and 11 .43% ,respectively ;the Pseudomonas aeruginosa and Acinetobacter bau‐mannii were the predominant species of gram‐negative bacteria ,accounting for 15 .71% and 13 .81% ,respective‐ly .The drug resistance rates of the gram‐positive bacteria and gram‐negative bacteria to the commonly used antibi‐otics showed an upward trend .CONCLUSION Most of the infections in the open fracture patients are caused by op‐portunistic pathogens .The drug resistance rates of the pathogens show an upward trend .It is necessary to strictly control the high risk factors for the complicated infections ,prevent the infections during the perioperative period , promote the wound healing as early as possible ,carry out the bacterial culture for wound secretions and the drug susceptibility testing in early stage ,and reasonably use antibiotics based on the results of drug susceptibility tes‐ting .