手部封闭治疗继发感染的致病菌谱分析及治疗

Pathogenic bacteria analysis and treatment strategy of the hand infections caused by local block therapy

目的 探讨并分析手部封闭治疗后继发感染的致病菌谱及相应的治疗对策.方法 2011年6月-2015年3月,对收治的12例手部封闭治疗后继发感染的患者,其中2例为手部湿疹行封闭注射治疗,10例为腱鞘炎封闭治疗,均进行扩创手术治疗及多次的细菌培养和药敏试验.通过分析致病菌谱和治疗结果以期探讨此类疾病的治疗对策.结果 12例患者的细菌培养均检出细菌,其中金黄色葡萄球菌5例,耐甲氧西林金黄色葡萄球菌5例,表皮葡萄球菌2例.通过反复清创结合合理的抗生素治疗,患者均实现了伤口愈合,平均每人接受4.5次手术,治疗时间平均48 d.结论 封闭注射要掌握严格的适应证,对老年人及伴有糖尿病、类风湿等合并症的患者要慎用,并严格无菌操作.早期治疗此类感染应优选对耐甲氧西林金黄色葡萄球菌敏感的抗生素.

Objective To explore the pathogenic bacteria analysis and treatment strategy of the hand infections caused by local block therapy. Methods We had dealt with altogether 12 hand infection cases caused by local block therapy from June 2011 to March 2015. 10 patients suffered from peritendinitis, and the other 2 patients suffered from eczema before their local block therapy. All the patients received germiculture and repeated debridement operations. We analyzed the pathogenic bacteria types and treatment results to explore a reasonable treatment strategy for such kind of infections. Results Pathogenic bacteria could be found in all the patients. Staphylococcus aureus were found in 5 cases, methiciUin- resistant staphylococcus aureus （MRSA） were found in 5 cases, and staphylococcus epidermidis were found in 2 cases. After repeated debridement operations with proper antibiotics usage, all the patients got the infection control and wound heal. Each patient received average 4.5 operations with average 48 days of treatment. Conclusion Local block therapy should have quite strict indications with aseptic techniques, and it should be used with great caution for the old patients and the patients with diabetes or rheumatoid diseases. Early treatment for such kind of infections should select the antibiotics sensitive to MRSA.