177例慢性难愈性创面病原体感染现状及耐药性的回顾分析

Retrospective analysis of pathogenic bacteria infections and drug resistance in 177 cases of chronic refractory wounds

目的监测观察慢性难愈性创面细菌的分布情况,分析导致创面感染的主要致病菌及其耐药性,为临床合理用药提供指导。方法收集2013年1月-2017年12月在安徽省第二人民医院烧伤外科治疗的177例慢性难愈性创面患者病例资料,进行回顾性分析。分离培养患者创面分泌物标本中的病原菌,经细菌自动生化分析仪鉴定病原菌类型,及病原菌分布情况,采用纸片扩散法检测致病菌的耐药率。结果177例患者创面标本中,共分离出174株病原菌,其中分离出多药耐药菌(Multiple Drug Resistant Organism,MDRO)38株占21.84%;174株病原菌中以革兰阴性菌为主,共128株占73.56%,革兰阳性菌41株占23.56%,真菌5株占2.87%;慢性难愈性创面主要革兰阴性菌的耐药率较高,其中大肠埃希菌对氨苄青霉素、氧哌嗪青霉素的耐药率较高,分别为88.89%、83.33%,肺炎克雷伯菌对氨苄青霉素的耐药率为100.00%,而铜绿假单胞菌对氨苄青霉素、阿莫西林/克拉维酸钾、头孢曲松钠、头孢噻肟、厄他培南、磺胺甲噁唑/甲氧苄啶、四环素的耐药率均为100.00%;而革兰阳性菌中金黄色葡萄球菌对氨苄青霉素、林可霉素、红霉素、青霉素的耐药率均为78.13%。结论慢性难愈性创面中以革兰阴性菌为主,耐药率较高,且存在部分MDRO,根据分布规律和耐药性指导临床合理用药;临床可同时配合对应的慢性难愈性创面处理方法,共同达到缩短病程和提高创面愈合质量的目的。

OBJECTIVE To monitor and observe the distribution of bacteria in chronic refractory wounds,analyze and discuss the main pathogenic bacteria causing wound infection and their drug resistance,so as to provide guidance for clinical rational drug use.METHODS The clinical data of 177 cases of chronic refractory wounds treated in the burn surgery department of the hospital from Jan.2013 to Dec.2017 were collected and analyzed retrospectively.The pathogenic bacteria in wound secretions were isolated,and the types and distribution of the pathogenic bacteria were identified by an automatic biochemical analyzer.The drug resistance of pathogenic bacteria was detected by disk diffusion method.RESULTS Among the 177 wound specimens,174 strains of pathogens were isolated,of which 38 strains were multiple drug resistant organisms(MDRO),accounting for 21.84%.The 174 strains of pathogens were dominated by Gram-negative bacteria,with 128 strains accounting for 73.56%.And there were 41 strains of Gram-positive bacteria accounting for 23.56%,and 5 strains of fungi accounting for 2.87%.The drug resistance rates of major Gram-negative bacteria in chronic refractory wounds were high.Escherichia coli was resistant to ampicillin and oxypiperazine,with drug resistance rates of 88.89%and 83.33%respectively.The drug resistance rate of Klebsiella pneumoniae to ampicillin was 100.00%,and the drug resistance rate of Pseudomonas aeruginosa to ampicillin,amoxicillin/clavulanic acid,bactericide,cefotaxime,ertapenem,sulfamethoxazole/trimethoprim and tetracycline was all 100.00%.Among the Gram-positive bacteria,Staphylococcus aureus showed drug resistance rate of 78.13%to ampicillin,lincomycin,erythromycin and penicillin.CONCLUSION Gram-negative bacteria are the main pathogens in chronic refractory wounds,which have strong drug resistance and part of them are MDRO.According to the distribution and drug resistance of the pathogens,rational drug use can be guided in clinic.Clinical treatment of chronic refractory wounds can be coordinated to shorten the course of disease and improve the quality of wound healing.