烧伤病房病原菌分离鉴定及耐药性分析

Isolation and identification of the pathogens isolated in burn unit

目的了解烧伤科病房感染的病原菌分布特点及对抗菌药物的耐药性,为临床合理使用抗生素及治疗提供更好的依据。方法调查收治烧伤患者的创面分泌物、血液、导管尖端、痰液、尿液、粪便等标本分离的2 580株病原菌,分析其分布特点及耐药情况。结果在分离的2 580株病原菌中,革兰氏阳性菌1 697株,占65.8%;革兰氏阴性菌863株,占33.4%;真菌20株,占0.8%。主要阳性菌为金黄色葡萄球菌,分离到821株,占31.8%,其中MRSA的比例达74.4%,只对万古霉素、替考拉宁、利奈唑胺敏感,其余抗生素几乎均耐药。阴性菌以阴沟肠杆菌最多,但耐药率逐渐下降,对多数药物敏感;鲍曼不动杆菌的分离率逐渐上升,且严重耐药,对头孢类耐药90%以上。结论此治疗中心细菌感染以革兰氏阳性菌为主,其中MRSA感染严重,有扩散趋势,且耐药率高,选择抗生素范围窄,问题不容忽视,急需解决;阴性菌鲍曼不动杆菌比例高,且呈多重耐药,治疗困难。

Objective To investigate the antibiotic resistance status in our hospital strains and provide the scientific evidence for the reasonable use of antibiotics. Methods 2 580 samples were obtained from patients in burn unit. The distribution and antibiotic resistance of bacteria strains of pathogens isolated from a variety of kinds of clinical samples in a burn unit were analyzed. Results A- mong all the strains of 2 580 pathogens, there were 1 697 strains of gram - positive bacteria （ 65.8% ） , 863 strains of gram - negative bacteria （ 33.4% ） and 20 strains of fungus （0.8 % ）. The major positive bacteria, Staphylococcus aureus, were accounting for 31.8%. In which, the proportion of MRSA was 74.4%. The resistant rate to commonly used antibiotics was high except vancomycin, teicoplanin and linezolid. In negative bacteria, Enterobacter cloacae were the largest. It was sensitive to most drugs and the resistance rates were de- creased. Acinetobacter baumannii has a gradually increased isolation rate, and it was resistant to more than 90% cephalosporins. Conclusion The Gram - positive bacteria is dominant bacteria in our unit. Infections caused by MRSA are serious, and has a tendency to spread. MRSA has a high resistance and a narrow range of antibiotics to select. This problem should not be ignored and it needs to be resolved. It is difficult for Acinetobacter baumannii to treat because of its multi - drug resistance.