2010—2014年烧伤患者感染病原菌及抗菌药物敏感性分析

Pathogenic bacteria and antimicrobial susceptibility of infected burn patients from 2010 to 2014

目的分析烧伤科患者感染主要病原菌与常用抗菌药物敏感性,为烧伤患者治疗、预防感染与合理选择抗菌药物提供依据。方法收集2010—2014年烧伤科患者感染病原菌575株,主要标本为创面分泌物、脓液、导管和血液。采用法国生物梅里埃VITEK 2 compact全自动细菌鉴定仪与VITEK MS全自动快速微生物质谱检测系统进行病原菌鉴定,纸片扩散法和最低抑菌浓度检测抗菌药物敏感性。采用细菌耐药检测网WHONET 5.6软件进行耐药性分析。结果 575株病原菌中,主要为金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、肺炎克雷伯菌与奇异变形杆菌,并检出多重耐药菌178株;大肠埃希菌与肺炎克雷伯菌对碳青霉烯类、丁胺卡那、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦抗菌药物的敏感率>78.2%;铜绿假单胞菌与鲍曼不动杆菌敏感率较低,且多重耐药菌占20.7%和32.9%;金黄色葡萄球菌对万古霉素、利奈唑胺、替考拉宁、呋喃妥因、氯霉素的敏感率>82.4%;肠球菌对万古霉素、利奈唑胺、呋喃妥因的敏感率>79.0%;检出万古霉素耐药肠球菌4株,占4.9%。结论病原菌对临床常用抗菌药物的耐药性较高,必须予以重视。临床医师治疗感染时,应在未使用抗菌药物前,正确送检细菌培养标本,尽早将经验用药转为病原治疗,以减少耐药菌株,提高临床治疗效果。

Objective To investigate the main pathogenic bacteria and antimicrobial susceptibility of infected burn patients,and to provide the basis for reasonable selection of antimicrobial agents,treatment of burns and prevention of infection. Methods A total of575 strains of pathogenic bacteria were collected from infected burn patients from 2010 to 2014,mainly specimens were blood,pus,catheters and wound secretion. Identification of pathogenic bacteria by French bio Merieux VITEK 2 compact automatic bacterial identification apparatus and Vitek MS automatic rapid microbial mass spectrometric detection system,K-B and MIC to detect antimicrobial susceptibilityt. Analysis of drug resistance of bacterial drug resistance using detection network WHONET 5. 6. Results Among the575 strains of pathogenic bacteria,S. aureus,P. aeruginosa,B. acinetobacter,E. coli,K. pneumoniae and P. mirabilis were identified and the detection of multiple drug resistant of 178 strains;the sensitive rate of E. coli and K. pneumoniae was above 78. 2% to antimicrobial agents such as carbapenem,amikacin,piperacillin / tazobactam and cefoperazone / sulbactam;the sensitivity of P. aeruginosa and B. acinetobacter was low,and the multiple drug resistant bacteria accounted for 20. 7% and 32. 9%;the sensitive rate of S. aureus was above 82. 4% to vancomycin,linezolid,teicoplanin,furantoin and chloramphenicol;the sensitive rate of enterococcus was above 79. 0%to vancomycin,linezolid and furantoin;4 VRE strains were detected,accounting for 4. 9%. Conclusion Pathogenic bacteria on the clinical commonly used antimicrobial agents resistance is above normal,which must be paid enough attention. When treat infection,before using antibiotics,clinicians should send correct specimens of bacteria culture to be inspected,perform pathogenic treatment instead of medication experience,reduce the drug resistant strains,and improve the clinical curative effect.