骨科与烧伤科住院患者创面感染革兰阴性菌分布及耐药性分析

Distribution and antibiotic resistance of main gram-negative bacteria isolated from wound surface of inpatients in orthopaedics department and burn department

目的分析骨科与烧伤科住院患者创面感染主要革兰阴性菌的分布及耐药性,为临床合理选用抗菌药物提供参考依据。方法对2011-2015年骨科与烧伤科住院患者创面分泌物细菌培养及耐药性数据进行统计分析。结果 2011-2015年骨科与烧伤科患者创面分泌物检出革兰阴性菌分别为691株、200株,骨科居前4位病原菌依次为阴沟肠杆菌(19.97%)、鲍氏不动杆菌(19.54%)、铜绿假单胞菌(17.08%)和肺炎克雷伯菌(8.39%),烧伤科病原菌居前4位依次为铜绿假单胞菌(26.50%)、鲍氏不动杆菌(15.50%)、阴沟肠杆菌(11.00%)和肺炎克雷伯菌(10.50%);铜绿假单胞菌对15种抗菌药物耐药率均为烧伤科高于骨科,除左氧氟沙星、替卡西林、氨曲南和多黏菌素E耐药率差别不明显外,其他11种差别均较明显(P<0.05);其中亚胺培南和美罗培南差别非常明显(P<0.001),鲍氏不动杆菌对21种抗菌药物除四环素耐药率烧伤科明显高于骨科外(P=0.028),其他20种差别均不明显,阴沟肠杆菌对26种抗菌药物耐药率骨科与烧伤科差别均不明显,肺炎克雷伯菌对26种抗菌药物耐药率除阿莫西林/克拉维酸、头孢西丁和头孢呋辛烧伤科明显高于骨科外(P<0.05),其他23种差别均不明显。结论骨科与烧伤科住院患者创面感染主要革兰阴性杆菌种类及构成比无明显差别;总体上烧伤科主要革兰阴性杆菌耐药性要强于骨科,其中以铜绿假单胞菌最为明显;临床应合理选用抗菌药物。

OBJECTIVE To investigate the distribution and drug resistance of major gram-negative bacteria existed on the surface of the wound in orthopaedics inpatients and burn inpatients,so as to provide some references for rational use of antibiotics in clinic.METHODS Statistical analysis about the bacteria from the wound secreta of orthopaedics inpatients and burn inpatients during 2011-2015 and their drug resistance were carried out.RESULTS The gram-negative bacteria isolated from the surface of the wound during 2011-2015 were 691strains from orthopaedics inpatients,and 200 strains from burn inpatients.For orthopaedics department,the top 4pathogenic bacteria were E.cloacae,A.baumanii,P.aeruginosaand K.pneumonia,accounting for 19.97%,19.54%,17.08% and 8.39%,respectively.For burn department,P.aeruginosa,A.baumannii,E.cloacae and K.pneumoniaaccounted 26.50%,15.50%,11.00% and 10.50%and ranked in top 4respectively.The resistant rates of P.aeruginosa to 15 antibiotics in burn department were all higher than those in orthopaedics department.Among 15 antibiotics,there were great differences on resistance rates to 11（P〈0.05）except levofloxacin,ticarcillin,aztreonam and polymyxin E.There were significant differences on resistance rates to imipenem and meropenem（P〈0.001）.Among the resistant rates of A.baumanii to 21 antibiotics in orthopaedics department and burn department,20 had no significant difference,while the resistant rate to tetracycline was higher in burn department than that in orthopaedics department obviously（P=0.028）.The resistant rates of E.cloacae to 26 antibiotics had no significant difference between orthopaedics department and burn department.Among the resistant rates of K.pneumoniaeto26 antibiotics in orthopaedics department and burn department,23 had no significant difference,while the resistant rates to amoxicillin/clavulanic acid,cefoxitin and cefuroxime were higher in burn department than those in orthopaedics department obviously（P〈0.05）.CONCLUSIONThere are no significant difference on major species of gram-negative bacteria and constituent ratio from the surface of the wound in orthopaedics inpatients and burn inpatients.In general,the resistant rates of major gram-negative bacteria were higher in burn department than those in orthopaedics department,especially P.aeruginosa.Antibiotics should be rationally chosen in clinical practice.