烧伤住院患者感染病原菌的分布及耐药性分析

Analysis of distribution and drug resistance of pathogenic bacteria in burn wards

目的·分析烧伤病房的病原菌菌种分布及耐药性的变化,为临床合理应用抗菌药物、减少耐药株产生及医院感染控制提供依据。方法·收集2011年1月—2014年12月烧伤病房送检标本的分离菌株,对感染来源、菌种分布及主要致病菌耐药率前后2年的变化趋势进行统计学分析。结果·共检出病原菌2 399株,革兰阴性杆菌(G-b)1 286株(53.61%),革兰阳性球菌(G+c)1 088株(45.35%),真菌25株(1.04%)。G-b常见为铜绿假单胞菌(447株,34.76%)和鲍曼不动杆菌(369株,28.69%),G+c最常见为金黄色葡萄球菌(489株,44.94%),真菌常见为白念珠菌(8株,33.33%)。后2年与前2年比较,金黄色葡萄球菌和鲍曼不动杆菌的检出率明显下降,铜绿假单胞菌检出率明显上升(P<0.05);铜绿假单胞菌和鲍曼不动杆菌对第3、4代头孢类、碳青霉烯类、氨基糖苷类和喹诺酮类抗菌药物耐药率较高(>80%),其变化无统计学意义(P>0.05);金黄色葡萄球菌仅对青霉素高度耐药(97.58%),对万古霉素100%敏感,对头孢唑啉、氨苄西林/舒巴坦、庆大霉素、左氧氟沙星和利福平的耐药率明显降低(P<0.05),耐甲氧西林金黄色葡萄球菌(MRSA)检出率由72.28%降至63.00%(P<0.05)。结论·烧伤病房检出多种院内感染病原菌,且耐药问题严重;改善管理并合理应用抗菌药物可减缓耐药菌发生,提高临床抗感染治疗和院内感染的控制效果。

Objective · To analyze changes in the type distribution and drug resistance of pathogenic bacteria isolated from burn wards and to provide evidence for rational use of antibiotics, reduction of drug-resistant isolates, and hospital infection control. Methods · Isolates from burn patients were collected from January 2011 to December 2014. Statistical analysis of infection sources, type distribution, and changes in resistance rates of main pathogens during the four year period was performed. Results. A total of 2 399 isolates were collected, including 1 286 （53.61%） gram-negative bacilli （G^＋b）, 1 088 （45.35%） gram-positive cocci （G^＋c）, and 25 （1.04%） fungi. The most common G^＋b pathogens were Pseudomonas aeruginosa （447, 34.76%） and Acinetobacter baumannii （369, 28.69%）. The most common G＋c pathogen and fungus were Staphylococcus aureus （489, 44.94%） and Candida albicans （8, 33.33%）, respectively. In the last two years, the detection rates of S.aureus and A.baumannii were significantly lower and the detection rate of P.aeruginosa was significantly higher than those in the first two years （P〈0.05）. Paeruginosa and A.baumannii showed high resistance （〉80%） to the third and fourth generation cephalosporins, carbapenems, aminoglycosides and quinolones, but the changes were not statistically significant （P〉0.05）. S.aureus was only highly resistant to penicillin （97.58%） and was 100% susceptible to vancomycin. Its resistance rates toward cefazolin, ampicillin/sulbactam, gentamicin, levofloxacin, and rifampin decreased significantly （P〈0.05）. The detection rate of methicillin-resistant S. aureus （MRSA） dropped from 72.28% to 63.00%. Conclusion. Many types of drug resistant bacteria were detected in burn wards. The drug resistance problem was serious. Improving management and rational use of antibiotics can reduce the occurrence of drug-resistant bacteria and increase the efficacy of clinical anti-infective treatment and nosocomial infection control.