烧伤患者行暴露治疗下创面感染病原菌分布与耐药性研究

Pathogenic bacteria distribution and drug resistance of wound infection in burn patients treated with exposure therapy

目的探究烧伤患者行暴露治疗下创面感染病原菌分布与耐药性,以期为后期临床治疗提供参考。方法选取2013年10月-2016年6月医院收治102例烧伤患者为研究对象,均经暴露治疗,对患者烧伤感染创面分泌物标本进行病原菌检测,并进行药物敏感性试验和耐药性分析。结果 102例创面感染患者共分离出病原菌147株,其中革兰阴性菌98株占66.67%,主要为鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌,革兰阳性菌43株占29.25%,主要为金黄色葡萄球菌,真菌6株占4.08%;常见革兰阴性菌对氨苄西林的耐药率均>90.00%,对氨苄西林/舒巴坦、头孢唑林、呋喃妥因、磺胺甲噁唑/甲氧苄啶等耐药率均>50.00%,但铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌对哌拉西林/他唑巴坦和头孢吡肟的耐药率较低;革兰阳性菌对青霉素G、红霉素、甲氧西林的耐药率均>50.00%,对呋喃妥因、喹奴普汀/达福普汀、替加西林和万古霉素等耐药率均为0。结论烧伤行暴露治疗患者创面感染病原菌以革兰阴性菌为主,对常见抗菌药物的耐药性较强,临床应加强对各类病原菌的检测,合理使用抗菌药物,降低创面感染率。

OBJECTIVE To explore the pathogenic bacteria distribution and drug resistance of wound infection in burn patients treated with exposure therapy,so as to provide guidance for clinical treatment.METHODS A total of102 burn patients admitted to our hospital from Oct.2013 to Jun.2016 were selected as research objects,and were all treated by exposure therapy.The pathogenic bacteria of secretion specimens from infected burn wounds were detected,and the drug sensitivity test and drug resistance analysis were carried out.RESULTS A total of 147 strains of bacteria were isolated from 102 cases of patients with wound infection,including 98strains（66.67%）of gram-negative bacteria,mainly for Acinetobacter baumannii,Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae,43strains（29.25%）of gram-positive bacteria,mainly Staphylococcus aureus;6strains（4.08%）of fungi.The drug resistant rates of common gram-negative bacteria to ampicillin were more than 90%,to ampicillin/sulbactam,cefazolin,nitrofurantoin and sulfamethoxazole/trimethoprim were more than 50%,but the drug resistant rates of P.aeruginosa,E.coli and K.pneumoniae to piperacillin/tazobactam and cefepime were lower.The drug resistant rates of gram-positive bacteria to penicillin G,erythromycin,and methicillin were more than 50%,to nitrofurantoin,quinupristin/dalfopristin,tigecillin and vancomycin were 0%.CONCLUSION The pathogens of burn wound patients treated with exposure therapy were mainly gram-negative bacteria,and had strong resistance to common antibiotics.It should strengthen the detection of pathogens in clinic,and rationally use antibiotics,so as to reduce the incidence of wound infection.