2073株烧伤患者创面分泌物病原菌种类分布及耐药性分析

Analysis of species distribution and drug resistance of 2,073 strains of bacteria isolated from burn wounds

目的对昆明医科大学第二附属医院烧伤患者创面分泌物病原菌种类分布及耐药性进行分析,为本院烧伤患者临床合理使用抗菌药物提供参考。方法采用回顾性分析方法选取2014年7月1日—2017年7月1日昆明医科大学第二附属医院烧伤科感染患者创面分泌物,按照全国临床检验操作规程对标本进行细菌的培养、分离鉴定,根据抗菌药物敏感性试验执行标准(CLSI 2014—2017版)进行耐药性分析。结果烧伤感染患者中共检出2073株细菌,革兰阳性菌共检出876株,其中金黄色葡萄球菌430株(49.1%)、表皮葡萄球菌196株(22.4%)、粪肠球菌75株(8.6%);革兰阴性菌共检出1197株,其中铜绿假单胞菌482株(40.3%)、大肠埃希菌164株(13.7%)、鲍曼不动杆菌128株(10.7%)。革兰阳性菌中金黄色葡萄球菌对青霉素G、四环素耐药性较高,分别为97.2%和72.3%,未发现利奈唑胺、万古霉素耐药菌株;革兰阴性菌中铜绿假单胞菌对氨苄西林、头孢曲松耐药率高达100%。用SPSSS 17.0软件对铜绿假单胞菌和大肠埃希菌的耐药性比较分析,结果显示对哌拉西林/三唑巴坦、头孢噻肟、头孢吡肟、亚胺培南、庆大霉素、环丙沙星、左氧氟沙星、复方磺胺甲噁唑的耐药率比较,差异有统计学意义(P<0.05)。3组不同年龄对氨苄西林、阿莫西林/克拉维酸、头孢曲松、头孢噻肟、复方磺胺甲噁唑的耐药率均在90%以上,对于哌拉西林/三唑巴坦,老年组耐药性更高,对头孢吡肟、庆大霉素,老年组耐药性更低。结论烧伤创面感染细菌以铜绿假单胞菌和金黄色葡萄球菌为主,多重耐药鲍曼不动杆菌引起的感染应加以重视,碳青霉烯类仍是革兰阴性菌感染治疗的首选药物,未发现对利奈唑胺、万古霉素耐药的金黄色葡萄球菌。

Objective To analyze wound secretion pathogen species distribution and drug resistance in burned patients who were from the Second Affiliated Hospital of Kunming Medical University, and provide the basis for clinical rational use of antibiotics for patients with bum wounds. Methods Retrospective analysis was conducted on samples from the Second Affiliated Hospital of Kunming Medical University of acute infections from July 1, 2014 to July 1, 2017. According to CLSI （2014-2017） standard, wound secretion specimens were used for the cultivation of bacteria, isolation, identification and drug resistance analysis. Results 2,073 strains of bacteria were detected from burned patients. There were 876 strains of gram-positive bacteria altogether, including Staphylococcus aureus （430strains, 49.1%）, Staphylococcus epidermis （196 strains, 22.4%）, and Enterococcus faecalis （75 strains, 8.6%）; there were 1,197 strains of Gram-negative bacteria in all, including Pseudomonas aeruginosa （482 strains, 40.3%）, E. coli （164 strains, 13.7%）, and Acinetobacter baumanni （128 strains, 10.7%）. The resistance rates of Gram-positive bacteria Staphylococcus aureus to penicillin G and tetracycline are 97.2% and 72.3% respectively. No strains were found to be resistant against linezolid and vancomycin. The resistance rates of Gram-negative Pseudomonas aeruginosa to ampicillin and ceftriaxone were as high as 100%. Analyzed with SPSSS17.0 software, the resistance rates of Pseudomonas aeruginosa and E. coli against piperacillin/tazobactam, cefotaxime, cefepime, imipenem, gentamycin, ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole were statistically significantly different （P〈0.05）. The resistance rates among the three groups with different ages were all higher than 90% to ampicillin, amoxicillin/ clavulanic acid, ceftriaxone, cefotaxime, and trimethoprim-sulfamethoxazole. The resistance rate of the elderly group to piperacillin-tazobactam was higher than the other two groups and the resistance rates against cefepime and gentamycin were lower than the other two groups. Conclusion The bacterial infections from bum wounds were mainly caused by Pseudomonas aeruginosa and Staphylococcus aureus. Great attention should be paid to multiple drug resistance of Acinetobacter baumannii infections. Carbapenem antibiotics are still the first choice for Gramnegative infection treatment. Staphylococcus aureus were not found to be resistant to linezolid and vancomycin.