创面感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing wound infections

目的分析创面感染病原菌分布及耐药性,为临床治疗提供参考。方法选取2016年1月-12月医院收治的手术病例8736例,分析病原菌分布及对常用抗菌药物敏感性。结果 8736例送检标本发生创面感染105例,占1.20%;105例患者标本共分离病原菌237株,其中革兰阴性菌140株,占59.1%,主要为大肠埃希菌、阴沟肠杆菌及铜绿假单胞菌;革兰阳性菌87株,占36.7%,主要为金黄色葡萄球菌、表皮葡萄球菌及屎肠球菌;药物敏感试验显示,主要革兰阴性菌对头孢哌酮/舒巴坦、亚胺培南、哌拉西林/他唑巴坦及美罗培南耐药率较低,主要革兰阳性菌对万古霉素、利奈唑胺及替考拉宁耐药率较低。结论临床上创面感染发生率较高,主要来源于骨外科,感染以创伤与手术切口为主,感染病原菌对常用抗菌药物具有较高耐药率,医师应合理选择抗菌药物,降低耐药菌发生,临床应加强对病原菌的培养及药敏监测。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing wound infections so as to provide guidance for clinical treatment.METHODS A total of 8736 patients who received surgical procedures from Jan 2016 to Dec 2016 were enrolled in the study,and the distribution of pathogens and drug susceptibility rates to commonly used antibiotics were observed.RESULTS The specimens were submitted from 105（1.20%）patients with wound infections among the 8736 patients.Totally 237 strains of pathogens were isolated from the specimens that were obtained from the 105 patients,140（59.1%）of which were gram-negative bacteria,and 87（36.7%）were gram-positive bacteria Escherichia coli,Enterobacter cloacae and Pseudomonas aeruginosa were the major species of the gram-negative bacteria;Staphylococcus aureus,Staphylococcus epidermidis and Enterococcus faecium were dominant among the gram-positive bacteria.The results of the drug susceptibility testing showed that the drug resistance rates of the main gram-negative bacteria to cefoperazone-sulbactam,imipenem,piperacillin-tazobactam and meropenem were low,and the drug resistance rates of the main gram-positive bacteria to vancomycin,linezolid and teicoplanin were low.CONCLUSION The clinical incidence of wound infections is high,it is higher in orthopedic surgery department,the wound and surgical incision are the major infection sites,the pathogens causing the infections are highly resistant to the commonly used antibiotics,and the clinicians should reasonably use antibiotics so as to reduce the drug-resistant strains.It is necessary for the hospital to strengthen the culture of pathogens and surveillance of drug susceptibility.