烧伤患者创面感染病原菌分布及耐药性监测

Distribution of pathogenic bacteria and monitoring drug resistance for wound infection in burn patients

目的分析烧伤患者病原菌分布及其耐药性,为临床合理使用抗菌药物提供依据。方法选取2014年1月-2015年12月新疆维吾尔自治区人民医院烧伤科123例烧伤患者,收集创面分泌物中分离的病原菌,采用K-B纸片扩散法进行药敏试验,并分析主要致病菌的耐药性。结果 123例患者共分离出174株病原菌,其中革兰阳性菌67株(38.5%),革兰阴性菌103株(59.2%),真菌4株(2.3%);金黄色葡萄球菌对青霉素、红霉素、复方新诺明、克林霉素等药物耐药率分别为92.2%、68.6%、58.8%、54.9%,对万古霉素、利奈唑胺、氨苄西林/舒巴坦100%敏感;鲍氏不动杆菌对头孢曲松、氨曲南、哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、环丙沙星等药物耐药率分别为100%、100%、87%、87%、82.6%、82.6%、82.6%,对头孢西丁、氯霉素100%敏感;大肠埃希菌对哌拉西林、头孢曲松、复方新诺明、环丙沙星、左氧氟沙星等药物耐药率分别为85.7%、76.2%、76.2%、71.4%、61.9%,对阿米卡星、亚胺培南、美罗培南、氯霉素100%敏感。结论烧伤患者创面感染以金黄色葡萄球菌和鲍氏不动杆菌为主,治疗时应进行药敏试验,根据药敏试验的结果合理使用抗菌药物。

Objective To explore the pathogenic bacteria distribution and drug resistance in burn patients,so as to provide the evidence for clinical rational use of antimicrobial agents for those patients. Methods Pathogenic bacteria were isolated from different kinds of wound in burn wards from Jan 2014 to Dec 2015. K-Bslip diffusion method was taken to carry out the drug susceptibility testing. Rate of drug resistance of Pathogenic bacteria was analyzed. Results A Total of 174 strains pathogenic bacteria were isolated,of which 103 strains of gram-negative bacteria（ 59. 2 %）,mainly for the bowman＇ s acinetobacter,e. coli,pseudomonas aeruginosa; 67 strains of gram positive bacteria（ 38. 5 %）,mainly staphylococcus aureus; 4 strains of fungi（ 2. 3 %）. The drug resistance rates of Staphylococcus aureeus to penicillin,erythromycin,sulfamethoxazole,trimethoprim and clindamycin were 92.2 %,68. 6 %,58. 8 % and 54. 9 % respectively,and no strains were found resistant to vancomycin,linezolid and ampicillin and Sulbactam; the drug resistance rates of Acinetobacter baumannii to ceftriaxone,aztreonam,piperacillin,piperacillin,cefepime,ceftazidime pentahydrate and ciprofloxacin were 100 %,100 %,87 %,87 %,82. 6 %,82. 6 % and 82. 6 %,and no strains were found resistant to cefoxitin,chloramphenicol; the drug resistance rates of Escherichia coli to piperacillin,ceftriaxone,sulfamethoxazole trimethoprim,ciprofloxacin,levofloxacin were 85. 7 %,76. 2 %,76. 2 %,71. 4 % and 61. 9 %,and no strains were found resistant to amikacin,Imipenem,meropenem and chloramphenicol. Conclusion Burn patients with liver wound infection were mainly caused by Staphylococcus aureeus and Acinetobacter baumannii. And drug sensitivity test should be performed during treatment,which results would be the basis of rational choosing of antibiotics.