老年患者难愈性创面的病原菌分布及耐药性

Distribution and drug resistance of pathogens isolated from refractory wound in elderly patients

目的分析老年患者难愈性创面的病原菌分布及耐药情况。方法对2011年1月至2014年12月间中国人民解放军第八五医院烧伤外科收治老年难愈性创面患者创面分离出的病原菌,采用VITEK2全自动微生物分析仪对病原菌进行鉴定,K-B纸片扩散法进行药物敏感试验,数据统计采用SPSS 17.0软件处理。结果分离出病原菌132株,其中革兰阳性菌28株（21.21%）,革兰阴性菌104株（78.79%）。常见病原菌为铜绿假单胞菌（42株,31.82%）、金黄色葡萄球菌（21株,15.91%）、大肠埃希菌（20株,15.15%）和鲍曼不动杆菌（16株,12.12%）。革兰阳性菌对青霉素、氨苄西林、红霉素、克林霉素、环丙沙星、氨苄西林/舒巴坦、阿莫西林/克拉维酸、头孢曲松的耐药率高于70%,对万古霉素、利奈唑烷、达托霉素和奎奴普丁/达福普汀的耐药率均为0%。革兰阴性菌对氨苄西林、阿莫西林/克拉维酸、头孢唑林、替卡西林/克拉维酸的耐药率高于70%,对头孢噻肟、左氧氟沙星、头孢呋辛、头孢吡肟的耐药率介于50%~70%,对美罗培南、亚胺培南、头孢哌酮/舒巴坦的耐药率低于30%。结论老年患者难愈性创面病原菌以革兰阴性菌居多,病原菌耐药严重,应引起临床重视。

Objective To analyze the distribution and drug resistance of pathogens isolated from refractory wound in elderly patients.Methods Pathogenic bacteria were isolated from refractory wounds in elderly patients from January 2011 to December 2014.The pathogens were identified by VITEK-2automatic microorganism analyzer.Antimicrobial susceptibility test was performed by K-B method and statistical analysis was performed with the SPSS 17.0software.Results A total of 132 strains of pathogens were isolated,of which Gram-positive bacteria and Gram-negative bacteria accounted for 21.21% and 78.79% respectively.The common pathogenic bacteria were Pseudomonas aeruginosa（31.82%）,Staphylococcus aureus（15.91%）,Escherichia coli（15.15%）and Acinetobacter baumannii（12.12%）.More than 70% of Grampositive bacteria were resistant to Penicillin,Ampicillin,Erythromycin,Clindamycin,Ciprofloxacin,Ampicillin/sulbactam,Amoxicillin/clavulnic and Ceftriaxone.No Gram-positive cocci strains were found resistant to Vancomycin,Linezolid,Daptomycin and Quinupristin/dalfopristin.The resistances of Gram-negative bacteria to Ampicillin,Amoxicillin/clavulanic acid,Cefazolin,Ticarcillin/clavulanic acid were higher than 70%,and those to Meropenem,Imipenem and Cefoperazone/sulbactam were lower than 30%.Conclusion Gram-negative bacteria are the major pathogenic bacteria isolated from refractory wound in elderly patients.The drug resistance rates of the pathogens are high,which is a clinical concern.