1261例骨科感染患者病原菌分布及耐药性分析

Analysis of pathogens distribution and drug resistance in 1261 orthopedics patients

目的分析骨科常见病原菌的分布及耐药情况,指导临床合理应用抗菌药物。方法收集广州军区广州总医院2014年1月1日至2015年9月30日骨科送检的标本共1 261例进行培养,用VITEK-2 Compact全自动细菌鉴定仪对培养出的菌株进行鉴定和药敏试验。结果 1 261例标本中培养出915株阳性标本,阳性率为72.56%。病原菌分离前7位以革兰阴性菌为主,其中铜绿假单胞菌(15.30%)、金黄色葡萄球菌(14.32%)和大肠埃希菌(11.04%)位居前三。产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌的检出率分别为71.29%和33.33%,耐甲氧西林金黄色葡萄球菌和耐甲氧西林表皮葡萄球菌的检出率分别为27.48%和80.82%。药敏显示大多数病原菌耐药性高,革兰阴性、阳性菌分别对亚胺培南、万古霉素敏感性最高。结论骨科感染病原菌以革兰阴性菌为主,且对大部分药物产生耐药,因此要合理使用抗生素,才能控制感染和降低耐药率。

Objective To analyze the common pathogens distribution and the drug resistance of orthopedics patients,in order to provide guidance for clinical rational use of antibiotics. Methods 1261 samples from orthopedics patients during January1, 2014 to September 30, 2015 were collected for pathogens culture, identification and drug sensitivity test with the VITEK-2Compact System. Results 915 strains pathogens were isolated from 1261 samples, and the positive rate was 72.56%.Majority of pathogens were G-bacilli in the top seven of pathogens distribution, and the first three pathogens were Pseudomonas aeruginosa（15.30%）, Staphylococcus aureus（14.32%）, and Escherichia coli（11.04%）. Extended spectrum beta lactamases of Escherichia coli and Klebsiella pneumoniae detection rates were 71.29% and 33.33%, respectively.Methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis detection rates were 27.48%and 80.82%, respectively. The resistance rates of G-bacilli to imipenem and G＋bacteria to vancomycin were low but resistance rates were high for other commonly used antibiotics. Conclusion G-bacilli were the most common pathogens isolated from the orthopedics patients, and they were resistant to most traditional penicillin. So these antibiotics should be used with caution in order to control pathogens infection and reduce drug resistance in these orthopedics patients.