骨科伤口感染人群病原菌测定、耐药性及其诊治措施

Pathogen detection,drug resistance and treatment in wound infection patients in department of orthopedics

目的通过对骨科伤口感染患者病原菌测定、耐药性及其诊治措施的分析,为临床上合理化用药及控制感染提供依据。方法回顾分析413例骨科患者的临床资料。结果 413例骨科患者的伤口分泌物标本中分离出病原菌281株,阳性率为68.0%,其中常见的致病菌主要是革兰阴性杆菌146株(占52.0%)以阴沟肠杆菌、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯杆菌等为主,其次是革兰阳性球菌129株(占45.9%),以金黄色葡萄球菌、表皮葡萄球菌等为主,真菌6株(占2.1%);常见致病菌耐药性均较高,其中阴沟肠杆菌对头孢唑林、氨苄西林/舒巴坦,铜绿假单胞菌对氨苄西林、头孢唑林、氨苄西林/舒巴坦的耐药程度均达到100%;经临床综合性诊治,采取有效防治与护理的措施,进一步改善其预后。结论骨科伤口感染患者常见致病菌耐药性较高,临床需及时根据药敏试验结果来进行合理性用药;密切关注其病情的发展,预防、控制耐药菌的传播并强化护理等多角度来进行诊治。

Objective Through the analysis of pathogenic bacteria detection,drug resistance,diagnosis and treatment measures in patients with orthopedic wound infection,to provide basis for the rational use of drugs and infection control. Methods All clinical data of 413 orthopedic patients were analyzed. Results Pathogenic bacteria was confirmed in 281 of 413 cases,with the prevalence of 68. 0%,including 146（ 52. 0%） aerobic gram-negative bacilli（ mainly Enterobacter cloacae,Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae）,followed by 129（ 45. 9%） Gram positive coccus（ mainly Staphylococcus aureus,Staphylococcus epidermidis） and 6（ 2. 1%） Fungus. The common pathogens all revealed high drug resistance. The drug resistance of Enterobacter cloacae to cefazolin,ampicillin/sulbactam,Pseudomonas aeruginosa to ampicillin,cefazolin,ampicillin/Sulbactam reached 100%. Through comprehensive clinical treatment and effective prevention and nursing measures,the prognosis can be improved. Conclusion The common wound infection patients in department of orthopedics have high drug resistance,so drugs should be given according to the results of drug sensitivity tests. As a result,close observation of disease,prevention and control of the spread of multi-drug-resistant bacteria and intensive nursing should be combined to improve treatment.