烧伤患者创面细菌感染的分布及其耐药性分析

The distribution and drug resistance analysis of bacteria isolated from burn wound

目的:探讨烧伤患者创面细菌感染的分布特点及耐药性。方法:对326例烧伤患者不同阶段的创面分泌物进行多次采集并进行细菌培养和鉴定,对革兰阴性及阳性菌的耐药性进行检测。结果:检出革兰阴性杆菌219株,病原菌的69.52%,比例最高的为铜绿假单胞菌(25.71%);革兰阳性球菌占25.08%,比例最高的为金黄色葡萄球菌(9.52%)。铜绿假单胞菌对复方磺胺甲口恶唑的耐药率最高(97.45%),对阿米卡星的耐药率最低(21.12%);鲍曼不动杆菌对氨曲南和头孢噻肟的耐药率最高(均为100.00%),对头孢哌酮/舒巴坦的耐药率最低(29.59%);大肠埃希菌对复方磺胺甲口恶唑的耐药率最高(79.48%),对亚胺培南的耐药率最低(0.00%);肺炎克雷伯菌对哌拉西林的耐药率最高(88.26%),对美罗培南的耐药率最低(1.42%)。金黄色葡萄球菌和表皮葡萄球菌对青霉素的耐药率均最高(94.62%,96.37%),对利奈唑胺和万古霉素的耐药率最低(均为0.00%)。结论:烧伤患者创面感染的病原菌类型主要为革兰阴性菌,并且耐药现象日益严重,临床上应掌握病原菌的分布特点并及时监测耐药情况,以指导合理用药,控制再次感染。

Objective：To investigate the bacterial infection distribution and drug resistance in burn wound. Methods：The bacteria from the wound secretion of different stages in 326 burn patients were cultured and identified. The drug resistance of gram negative and gram positive bacteria were detected. Results：The gram negative bacilli accounted for 69. 52%（219 trains） of 315 strains of pathogenic bacteria,the proportion of pseudomonas aeruginosa was the highest（25. 71%）. The gram positive cocci accounted for 25. 08%,the proportion of staphylococcus aureus was the highest（9. 52%）. The drug resistance rates of pseudomonas aeruginosa to cotrimoxazole and amikacin were the highest（97. 45%） and lowest（21. 12%）,respectively. The drug resistance rates of bauman acinetobacter to aztreonam ＆ cefotaxime and cefoperazone/sulbactam were the highest（100. 00%） and lowest（29. 59%）,respectively. The drug resistance rates of Escherichia coli to cotrimoxazole and imipenem were the highest（79. 48%） and lowest（0. 00%）,respectively. The drug resistance rates of klebsiella pneumoniae to piperacillin and meropenem were the highest（88. 26%） and lowest（1. 42%）, respectively. The drug resistance rates of staphylococcus aureus＆Staphylococcus aureus to penicillin and linezolid＆vancomycin were the highest（94. 62%＆ 96. 37%） and lowermost（0. 00% and 0. 00%）,respectively. Conclusions：The Gram-negative bacteria is mainly pathogenic bacteria in burn wound infection,the drug resistance of which increases. Knowing the distribution characteristics of pathogenic bacteria and timely monitoring its drug resistance can guide the rational drug use and control infection again.