伤口感染病原菌分布与耐药性分析

The pathogen distribution and drug resistance of wound infection

目的探讨伤口感染患者病原菌分布及耐药性情况,为临床合理使用抗菌药物提供依据。方法收集2017年1―12月东莞市中医院伤口感染患者的伤口分泌物进行细菌培养,采用Vitek-2Compact全自动微生物鉴定仪及配套卡进行细菌鉴定及药敏试验。结果 1 156份伤口分泌物标本中检出病原菌465株,检出率为40.2%:其中革兰阴性杆菌240株,占51.6%,革兰阳性球菌202株,占43.4%,真菌23株,占5.0%,检出率从高到低的前4位依次为金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌,分别占34.0%、16.3%、9.2%、7.7%;19.0%的金黄色葡萄球菌为耐甲氧西林金黄色葡萄球菌;大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)的菌株分别占47.4%和33.3%。结论该院伤口感染病原菌种类较多,以革兰阴性杆菌为主,但金黄色葡萄球菌位居第一,多重耐药菌种类和数量不断增多,临床医师应根据药敏结果合理使用抗菌药物,提高临床抗感染治疗的效果,减少耐药菌株的产生。

Objective To retrospectively analyze the pathogenic bacterial distribution and drug resistance in patients with wound infection in our hospital,and to provide a basis for clinically rational ues of antibacterial drugs.Methods The wound secretions from patients with wound infection in Dongguan Traditional Chinese Medicine hospital from January 1,2017 to December 31,2017 was performed the bacterial culture.The bacterial identification and drug susceptibility test were performed by using the Vitek-2 Compact automatic microorganism identification in-strumen.The dates were statistically analyzed by adopting the WHONET 5.6 software.Results A total of 465 strains of pathogenic bacteria have been isolated from 1 156 wound secretions,and the detection rate was 40.2%.A total of 465 strains of bacteria were isolated from wound secretions,there were 240(51.6%)strains of gram-negative bacilli and 202(43.3%)strains of gram-positive cocci and 23(5.0%)strains of fungi;the Staphylococcus aureus(34.0%),Escherichia coli(16.3%),Pseudomonas aeruginosa(9.2%)and Klebsiella pneumoniae(7.7%)ranked the top 4 species of pathogens.And 19.0%of S.aureus strains were methicillin-resistant S.aureus;extended-spectrumβ-lactamase(ESBLs)-producing E.coli and K.pneumoniae accounted for 47.4%and 33.3%,respectively.Conclusion There are many kinds of pathogens in the wound infection of the hospital,mainly gram-negative bacilli,but the top is Staphylococcus aureus.Multidrug-resistant strains and number are continuously increased.Clinicians should rationally and correctly use the antibacterial drugs based on the drug sensitivity test results for improving the effect of clinical anti-infection treatment and reduce the production of resistant strains.