整形病区扩张器置入部位感染病原菌分析与感染的临床治疗

Analysis of the bacteria spectrum and clinical treatment of topical skin infection during soft tissue expander implantation

目的通过对感染病原菌、药敏结果、感染后处理方式及结果的分析总结，为临床工作提供参考。方法2003年1月至2012年12月在西京整形医院行扩张器置入术后感染患者共121例，统计分析感染病原菌检查、药敏结果、治疗方法及结局。结果本组共121例，其中29例标本送细菌培养及药敏试验，23例细菌培养阳性，6例未见细菌生长。感染细菌金黄色葡萄球菌20例（86．96％），表皮葡萄球菌MRCNS1例，克氏柠檬酸杆菌1例，嗜水气单胞菌1例。药敏结果80％以上对头孢唑林、苯唑青霉素、左氧氟沙星等抗生素敏感。采用局部换药、清创引流、静脉滴注敏感抗生素等不同方法处理，最终感染治愈率为100％，扩张术成功率为89．33％。结论扩张器置入部位感染的主要病原菌是金黄色葡萄球菌，治疗应以局部换药、清创引流等外科手段为主，全身应用敏感抗生素为辅，根据具体情况采取不同治疗策略。

Objective To analyze the identification and antibiotics susceptibility of infectious bacteria obtained from the topic skin infection during soft tissue expander implantation. Methods A retrospective analysis of 121 cases with local infections during soft tissue expander implantation between 2003 to 2012 in Department of Plastic and Reconstructive Surgery, Xijing Hospital was performed. The efficacy of clinical management of local infection was evaluated. Laboratory examination on exudates bacterial pathogen and antibiotic susceptibility were performed. Results Based on the severity of wound infection, change of dressings, wound debridement, exudates drainage and intravenous antibiotics administration were applied. All infections were successfully controlled although the expanders were removed in 16 cases with severe infections. Total success rate of expansion in this cohort was 89. 33%. Twenty-nine exudates samples collected from either skin rupture wounds or skin outlets of connector tubes of externally placed infusion ports in 29 patients underwent bacterial culture and antibiotic susceptibility test. The 23 samples showed positive while the rest 6 samples showed negative on bacterial identification in the bacterial culture test. Staphylococcus aureus strain was found in 20 samples （86.96%） , Staphylococcus epidermidis in 1 sample, Klinefelter Citrobacter in 1 sample, and Aeromonas hydrophila in 1 sample. More than 80% of the pathogens were susceptive to cefazolin, oxacillin, and levofloxacin. Conclusions Staphylococcus aureus is the main pathogen of infection at expander implantation site. The local dressing change, surgical debridement, continuous infusion drainage, and the use intravenous antibiotics are the effective managements.