九年间烧伤患者病原菌分布特点及耐药情况分析

Analysis of distribution and drug resistance of pathogens of burn patients during 9 years

目的 了解烧伤患者病原菌分布特点及耐药情况。方法 收集2007年1月—2015年12月笔者单位收治的11 510例住院烧伤患者的创面分泌物、深静脉导管、静脉血、大便、中段尿液、痰液、穿刺液、咽拭子标本25 286份，行细菌培养，共分离出3 357株菌株。采用API细菌鉴定板条和全自动细菌鉴定仪进行菌种鉴定，K－B纸片扩散法进行药物敏感试验，检测金黄色葡萄球菌、铜绿假单胞菌、鲍氏不动杆菌及肺炎克雷伯菌对28种常用抗菌药物的耐药情况。采用WHONET 5.6软件统计各年度革兰阴性菌和革兰阳性菌构成比、各年度检出病原菌分布情况及9年间检出的金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌及鲍氏不动杆菌对28种常用抗菌药物的耐药情况。对数据行线性模型曲线拟合。结果 （1）2007—2015年，革兰阴性菌构成比分别为41.22%（101/245）、41.88%（165/394）、45.92%（169/368）、42.54%（208/489）、52.35%（267/510）、56.89%（194/341）、58.99%（210/356）、56.95%（172/302）、50.28%（177/352），呈明显上升趋势（R^2=0.625，P〈0.05）；革兰阳性菌构成比分别为58.78%（144/245）、58.12%（229/394）、54.08%（199/368）、57.46%（281/489）、47.65%（243/510）、43.11%（147/341）、41.01%（146/356）、43.05%（130/302）、49.72%（175/352），呈明显下降趋势（R^2=0.625，P〈0.05）。9年间，金黄色葡萄球菌构成比一直居于首位，铜绿假单胞菌和肺炎克雷伯菌构成比呈明显上升趋势（R^2=0.811、0.778，P〈0.01）。（2）9年间，金黄色葡萄球菌对庆大霉素和利福平的耐药率呈明显下降趋势（R^2=0.727、0.766，P〈0.01），对磷霉素的耐药率始终处于较低水平（4.6%-19.5%）；铜绿假单胞菌对头孢他啶、环丙沙星的耐药率无明显变化趋势（R^2=0.023、〈0.001，P〉0.05），而对其他10种常用抗菌药物的耐药率呈明显上升趋势（R^2=0.764、0.793、0.785、0.768、0.752、0.749、0.789、0.786、0.706、0.629，P〈0.01）；鲍氏不动杆菌对氨苄西林/舒巴坦的耐药率呈明显下降趋势（R^2=0.652，P〈0.01），对阿米卡星的耐药率呈明显上升趋势（R^2=0.531，P〈0.05）；肺炎克雷伯菌对哌拉西林、氨苄西林/舒巴坦、头孢呋辛、头孢他啶、头孢噻肟、头孢吡肟、亚胺培南、美罗培南、阿米卡星、庆大霉素的耐药率呈明显上升趋势（R^2=0.481、0.672、0.694、0.532、0.810、0.641、0.809、0.709、0.579、0.810，P〈0.05或P〈0.01）。结论 笔者单位2007—2015年收治住院烧伤患者检出铜绿假单胞菌和肺炎克雷伯菌等革兰阴性菌构成比显著上升，但金黄色葡萄球菌构成比仍居于首位；细菌耐药情况严重，金黄色葡萄球菌仅对磷霉素耐药率一直处于较低水平，铜绿假单胞菌对除头孢他啶和环丙沙星外的10种常用抗菌药物的耐药率显著上升，鲍氏不动杆菌仅对氨苄西林/舒巴坦的耐药率显著下降，肺炎克雷伯菌对大多数常用抗菌药物的耐药率显著上升。

Objective To investigate distribution and drug resistance of pathogens of burn patients. Methods A total of 3 357 strains were cultured and isolated from 25 286 specimens of wounds excretion, deep venous catheters, venous blood, stool, mid-stream urine, sputum, puncture fluid, and throat swab of 11 510 burn patients hospitalized in our burn wards from January 2007 to December 2015. After being iden- tified by API bacteria identification panels and automatically bacteria identification equipment, drug-resist-ances of Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii , and Klebsiella pneumoniae to 28 common antibiotics were tested by drug sensitivity test with K-B paper disk diffusion meth- od. The WHONET 5.6 software was used to analyze constituent ratio of gram-negative bacteria and gram- positive bacteria in each year, distribution of pathogens in each year, and drug resistance of the above-men- tioned 4 pathogens in 9 years to 28 common antibiotics. Data were analyzed by the linear model curve fitting. Results （1） From 2007 to 2015, constituent ratios of gram-negative bacteria were respectively 41.22% （101/245）, 41.88% （165/394）, 45.92% （169/368）, 42.54% （208/489）, 52.35% （267/510）, 56.89% （194/341） , 58.99% （210/356） , 56.95% （172/302） , and 50.28% （177/352）, with signifi-cantly increasing trend （ R^2 = 0. 625, P 〈 0.05 ） ; constituent ratios of gram-positive bacteria were respec- tively 58.78% （144/245）, 58.12% （229/394）, 54.08% （199/368）, 57.46% （281/489）, 47.65% （243/510）, 43. 11% （147/341）, 41.01%（146/356）, 43.05% （130/302）, 49.72% （175/352）, with significantly decreasing trend （ R^2 = 0. 625, P 〈 0.05 ）. In 9 years, constituent ratio of Staphylococcus aureus ranked the first in all bacteria, and constituent ratios of Pseudomonas aeruginosa and Klebsiella pneumoniae were with significantly increasing trend （ R^2 = 0. 811 , 0. 778, P 〈 0.01 ）. （2） In 9 years, drug-resistant rates of Staphylococcus aureus to gentamyein and rifampicin were with significantly decreasing trend （ R^2 = 0. 727, 0. 766, P 〈 0.01 ） ; drug-resistant rates of Staphylococcus aureus to phosphonomycin were always in lower levels of 4.6% to 19.5% . In 9 years, drug-resistant rates of Pseudomonas aeruginosa to ceftazidime and ciprofloxacin had no significant change in trend （ R^2 = 0. 023, 〈 0. 001 , P 〉 0.05） , while drug-resistant rates of Pseudomonas aeruginosa to other 10 common antibiotics were with significantly increasing trend （ R^2 =0. 764, 0. 793, 0. 785, 0. 768, 0. 752, 0. 749, 0. 789, 0. 786, 0. 706, 0. 629, P 〈 0.01 ）. In 9 years, drug-resistant rate ofAcinetobacter baumannii to ampicillin/sulbactam was with sig- nificantly decreasing trend （ R 2 = 0. 652, P 〈 0.01 ） , and drug-resistant rate of Acinetobacter baumarrni- to amikacin was with significantly increasing trend （ R^2 = 0. 531, P 〈 0.05 ）. In 9 years, drug-resistant rates of Klebsiella pneumoniae to piperacillin, ampicillin/sulbactam, cefuroxime, ceftazidime, cefotaxime, cefepime, imipenem, meropenem, amikacin, and gentamicin were with obviously increasing trend （ R^2 = 0.481, 0.672., 0.694, 0.532, 0.810, 0.641, 0.809, 0.709, 0.579, 0.810, P 〈0.05 or P 〈0.01）. Conclusions Constituent ratios of gram-positive bacteria of Pseudomonas aeruginosa and Klebsiella pneumoniae of burn patients hospitalized in our burn wards from 2007 to 2015 were significantly increased, while constituent ratios of Staphylococcus aureus of those children always ranked the first. Drug-resistence of bacteria of those children in our burn wards was serious. Drug-resistant rate of Staphylococcus aureus only to phosphonomycin was always in lower level. Drug-resistant rates of Pseudomonas aeruginosa to 10 common antibiotics except ceftazidime and ciprofloxacin were significantly increased. Drug-resistant rate of Acinetobacter baumannii only to ampicillin/sulbactam was significantly decreased. Drug-resistant rates of Klebsiella pneumoniae to most common antibiotics were significantly increased.