开放性骨折术后创面感染的病原菌及耐药性分析

Pathogens and Antimicrobial Resistance of Postoperative Wound Infection in Open Fracture Patients

目的了解开放性骨折术后创面感染患者的病原菌分布及其药物敏感性,为临床抗菌药物的合理使用提供科学依据。方法收集2012年6月至2016年6月昆明医科大学第一附属医院骨科开放性骨折术后感染患者标本295例进行病原菌培养,其中男性187例,女性108例;年龄14~79岁,平均(39.7±5.4)岁。对病原菌进行鉴定和药敏检测,分析病原菌分布及耐药性。结果 295例开放性骨折术后感染患者中年龄为20~40岁、40~60岁组的患者较多,分别占37.97%和35.25%;295例共分离出病原菌345株,革兰阴性菌218株,占63.19%,以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌为主;革兰阳性菌112例,占32.46%,以金黄色葡萄球菌和表皮葡萄球菌为主;真菌15株,占4.35%。革兰阳性细菌对青霉素普遍耐药,耐药率达96%以上,万古霉素的耐药率最低,未见耐药菌株出现。革兰阴性细菌对常用抗生素药物敏感性最高的是亚胺培南,最低的是氨苄西林。结论开放性骨折术后创面感染的病原菌以革兰阴性菌为主,不同的病原菌耐药性差异较大。临床医师应根据药敏结果合理使用抗菌药物,采取积极有效的措施预防和控制感染。

Objective To investigate the distribution and antimicrobial susceptibility of pathogens causing postoperative wound infection in open fracture patients,and provide evidence for rational use of antimicrobial agents in clinical practice.Methods Specimens of patients with postoperative wound infection in the first affiliated hospital of Kunming medical university between June 2012 and June 2016 were collected and underwent microbial culture.Pathogens were identified.Antimicrobial susceptibility tests were performed.Distribution of pathogens and antimicrobial resistance were analyzed.Results Among the 295 patients with postoperative wound infection,male and female accounted for 63.39%and 36.61% respectively.37.97% aged 20-40 years and 35.25% of patients aged 40-60 years.A total of 345 strains were isolated.218（63.19%）of the strains were gram-negative bacteria,mainly Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumonia.112（32.46%）of them were gram-positive bacteria,mainly Staphylococcus auerus and Staphylococcus epiderrmidis.And 15（4.35%）of them were fungi.The result of antimicrobial susceptibility testing for the major gram-negative pathogens showed that the drug resistance rate to penicillin was the highest（〉96%）and the drug resistance rate to vancomycin was the lowest（0%）.The result of antimicrobial susceptibility testing for the major gram-positive pathogens showed that the drug resistance rate to imipenem was the lowest,the drug resistance rate to ampicillin was the lowest.Conclusion The main pathogens causing postoperative wound infection are gram-negative bacteria,different pathogens have different drug resistance.It is necessary for clinicians to use the antimicrobial agents rationally during clinical treatment according to antimicrobial susceptibility testing results and effective measures should also be taken to prevent and control infection.