2014-2018年某院烧伤患者感染细菌分布及耐药性分析

Analysis of Bacterial Distribution and Drug Resistance of Burn Patients in a Hospital from 2014 to 2018

目的:分析笔者所在医院烧伤患者感染细菌分布及耐药性,为临床合理使用抗生素提供依据。方法:回顾性分析2014-2018年烧伤患者创面分泌物、痰液、深静脉导管、血液标本中分离的细菌及耐药性。结果:烧伤患者感染细菌主要来源于创面分泌物标本,在所有送检标本中共分离出细菌1 019株,其中革兰阴性菌565株,占55.5%,革兰阳性菌454株,占44.5%,分离的前五位细菌依次为金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌、大肠埃希氏菌、凝固酶阴性葡萄球菌,其中鲍曼不动杆菌的分离率呈现逐年上升趋势,所有分离菌株对常用抗菌药物的耐药率均呈现逐年上升趋势,2014-2018年肠杆菌科细菌ESBLs检出率明显上升(57.9%~88.9%),2018年MRSA检出率仍高达64.1%。结论:烧伤患者细菌感染以金黄色葡萄球菌和鲍曼不动杆菌为主,主要感染细菌的产酶情况和耐药情况较为严重,应加强烧伤患者细菌耐药性监测,根据药敏试验合理选择抗菌药物,以延缓细菌的耐药率。

Objective:To analyze the distribution and drug resistance of bacteria in burn patients in our hospital,and to provide evidence for clinical rational use of antibiotics.Method:The bacteria isolated from wounds,sputum,deep vein catheters and blood samples from burn patients in our hospital from 2014 to 2018 and drug resistance were retrospectively analyzed.Result:The infected bacteria in burn patients were mainly from wound secretion specimens.Total of 1 019 strains of bacteria were isolated from all the specimens,including 565 Gram-negative bacteria(55.5%of total),and 454 Gram-positive bacteria(44.5%of total).The top five bacteria were Staphylococcus Aureus,Acinetobacter Baumannii,Pseudomonas Aeruginosa,Escherichia Coli,and Coagulase-negative Staphylococci.The detection rate of Acinetobacter Baumannii increased year after year.They were highly resistant to other commonly used antibiotics.The resistance rate of antibacterial drugs showed an increasing trend year by year.The detection rate of ESBLs in Enterobacteriaceae increased significantly from 2014 to 2018(57.9%-88.9%).The detection rate of MRSA was as still high as 64.1%in 2018.Conclusion:The bacterial infection of burn patients is mainly Staphylococcus Aureus and Acinetobacter Baumannii.The enzyme production and drug resistance of the main infected bacteria are serious.It is necessary to strengthen the monitoring of bacterial resistance in burn patients.Antibiotics shall be rationally selected according to the drug sensitivity test to delay the resistance rate of bacteria.