457例住院患者伤口分泌物细菌分布及耐药性分析

Analysis of pathogens distribution and drug resistance of wound secretion in 457 inpatients

目的了解住院患者伤口分泌物常见病原菌分布特征及耐药性,为临床合理用药提供参考。方法对2012年1月至2013年12月1 045份伤口分泌物标本中培养分离出的457株病原菌的分布特征及耐药性进行回顾性分析。结果1 045份伤口分泌物标本中分离出457株病原菌,阳性率43.7%。其中革兰阴性菌占61.9%(283/457),革兰阳性菌占37.4%(171/457),真菌占0.7%(3/457)。检出前三位病原菌分别为金黄色葡萄球菌(21.2%)、铜绿假单胞菌(14.9%)、大肠埃希菌(14.4%)。耐甲氧西林金黄色葡萄球菌(MRSA)检出率34.0%,未发现耐万古霉素的金黄色葡萄球菌。大肠埃希菌的超广谱β-内酰胺酶(ESBLs)检出率为63.6%。铜绿假单胞菌、大肠埃希菌对亚胺培南、美洛培南和头孢哌酮/舒巴坦耐药率均很低,对其余抗菌药物则表现出不同的耐药率。结论伤口分泌物中以金黄色葡萄球菌和革兰阴性杆菌为主,临床应根据细菌药敏结果科学合理用药,防止抗菌药物滥用,减少耐药菌株的产生。

Objective To analyze the common pathogens distribution and the drug resistance of wound secretion in inpatients,in order to provide reference for rational use of antibiotics. Method Retrospectively analyzed the results of the distribution and drug resistance analysis for 457 strains pathogens isolated from 1 045 specimens of wound secretion between January 2012 and December 2013. Results 457 strains pathogens were isolated from 1 045 specimens of wound secretion. The positive rate was 43.7%. The Gram-negative bacilli infection rate was 61.9%（283 / 457）.The Gram-positive bacteria infection rate was 37.4%（171 / 457）.The fungus infection rate was 0.7%（3 / 457）. The first three pathogens were Staphylococcus aureus（21.2%）,Pseudomonas aeruginosa（14.9%）,and Escherichia coli（14.4%）.Methicillin-resistant Staphylococcus aureus（MRSA） detection rate was 34.0%. Staphylococcus aureus resistant to vancomycin had not been found. Extended Spectrum Beta Lactamases（ESBLs） of Escherichia coli detection rate was63.6%.The drug resistance rate of Pseudomonas aeruginosa and Escherichia coli to Imipenem, Meropenem and Cefoperazone / Sulbactam were very low. For the rest of antibacterial drugs the isolated pathogens showed different resistance rates. Conclusions Staphylococcus aureus and Gram-negative bacilli were the most common pathogens isolated from the wound secretion. Clinicians should use drugs according to the sensitivity test results and prevent the overuse of antibacterial drugs,and reduce the appearance of drug resistant bacteria.