烧伤病房患者多重耐药菌检测及耐药性分析

The detection and drug resistance of multidrug-resistant organisms in burn unit

目的：分析烧伤病房患者多重耐药菌发生情况，并对其耐药性进行分析。方法标本接收后分别划线接种于不同平板进行细菌分离培养及鉴定，对分离出的病原菌进行药物敏感性检测，结果依据美国临床实验室标准化研究所（CLSI）2013年版 CLSI 进行判断。对多重耐药菌产生情况进行统计分析。结果耐甲氧西林金黄色葡萄球菌（MRSA）和产超广谱β-内酰胺酶（ESBLs）检出数量最多，分别为87株（38．3％）和73株（32．2％）。MRSA 对青霉素完全耐药，对庆大霉素、环丙沙星、左氧氟沙星、四环素及利福平耐药率均＞70．0％，对红霉素和克林霉素耐药率为52．9％，对莫西沙星和复方磺胺甲唑耐药率分别为16．1％和18．4％，对万古霉素、利奈唑烷和替加环素完全敏感。ESBLs 对头孢曲松、氨曲南和庆大霉素耐药率均＞60．0％，对阿莫西林／棒酸、头孢他啶和妥布霉素耐药率为40．0％左右，对哌拉西林／他唑巴坦、厄他培南、阿米卡星和头孢哌酮／舒巴坦耐药率低于20．0％，对亚胺培南和美罗培南完全敏感。耐碳青霉烯类抗菌药物肠杆菌科细菌（CRE）除了阿米卡星（18．2％）外，对其他常用抗菌药物耐药率均＞45．0％。耐碳青霉烯类抗菌药物鲍曼不动杆菌（CR-AB）除左氧氟沙星（25．0％）外，对常见抗菌药物的耐药率均≥80．5％。多重耐药／泛耐药铜绿假单胞菌（MDR／PDR-PA）对常见抗生素耐药率均≥55．0％。结论烧伤病房多重耐药菌检出率较高，耐药情况较严重。临床医生需合理应用抗生素，对于多重耐药菌可联合用药，尽量避免抗生素滥用，以控制或减缓多重耐药菌的产生。

Objective To detect the generation of multidrug -resistant organisms（MDROs）in our burn unit and analyze the antibiotic susceptibility.Methods The specimens were inoculated into different disks to isolate and cultivate bacteria.The antibiotic susceptibility of pathogens isolated was detected and judged by CLSI（clinical and laboratory standards institute）2012.The productive rate of MDROs were detected.Results The detection rate of MRSA and ESBLs were the most,87 （38.3%）and 73 （32.2%）respectively.MRSA was absolutely resistant to penicillin,the drug resistant rates to gentamicin,ciprofloxacin,levofloxacin,tetracycline,and rifampicin were above 70.0%,to erythromycin and clindamycin 52.9%,to moxifloxacin and SMZ -TMP 16.1% and 18.4% respectively, and absolutely sensitive to vancomycin,linezolid and tigecycline.The drug resistant rates of ESBLs to ceftriaxone, aztreonam and gentamicin were above 60.0%,to amoxicillin/clavulanic acid,ceftazidime and tobramycin were about 40.0%,to piperacillin -tazobactam,ertapenem,amikacin and cefoperazone /shubatan were below 20.0%,and absolutely sensitive to imipenem and meropenem.The drug resistant rates of CRE to the familiar antibiotics were above 45.0% except amikacin （18.2%）,CR -AB to the common antibiotics were above 80.5% except levofloxacin （25.0%）,and MDR/PDR -PA to the familiar antibiotics were above 50.0%.Conclusion The detection and drug resisrance rate of multidrug -resistant organisms in our burn unit was high.The clinic should pay more attention to use antibiotics reasonablely and may combine drugs to treat MDROs.It is necessary to use the antibiotic reasonably within different people to postpone the generation of MDROs.