骨科伤口感染细菌学研究与临床合理应用抗生素分析

Bacteriological study of orthopedic wound infection and analysis of clinical rational application of antibiotics

目的研究骨科伤口感染细菌分布及其耐药性。方法选取我院2019年1月—2020年6月骨科患者送检的50例清创术后创面新鲜组织标本或术后切口分泌物作为研究标本,对不同骨折部位进行统计,观察分离菌的分布情况,分析细菌耐药性变化。结果不同开放性骨折感染部位不同,其中感染部位以胫腓骨、足部骨折多见;共送检50例清创术后创面新鲜组织标本或术后切口分泌物,检出病原菌54株,革兰阳性菌以金黄色葡萄球菌、凝固性阴性葡萄球菌为主,革兰阴性菌以大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌为主,分离的病原菌中前5位为依次为金黄色葡萄球菌33.33%、大肠埃希菌25.93%、鲍曼不动杆菌14.81%、凝固性阴性葡萄球菌11.11%、铜绿假单胞菌5.56%。金黄色葡萄球菌、凝固性阴性葡萄球菌对万古霉素敏感性较强;大肠埃希菌、铜绿假单胞菌对丁胺卡那霉素呈现较高的敏感性,鲍曼不动杆菌对头孢他啶、丁胺卡那霉素具有较高敏感性。结论骨折感染部位以胫腓骨、足部骨折多见,清创术后创面新鲜组织标本或术后切口分泌物以革兰阴性菌为主,不同菌种耐药性之间存在差异。在用药过程中应高度重视细菌培养,检测病原菌及耐药性,合理使用抗菌药物,减少耐药菌生成。

Objective To analyze the bacteriological study of orthopedic wound infection and the clinical rational application of antibiotics.Methods The fresh tissue specimens from debridement wounds or postoperative incision secretions of 50 orthopedic patients in the Foshan Nanhai Sixth People's Hospital from January 2019 to June 2020 were selected as research specimens,and the different fracture sites were given infection cause analysis,and the distribution of isolated bacteria was observed,and the changes of bacterial resistance were analyzed.Results The infection sites of different open fractures were different.Among them,the infection sites were mostly tibiofibula fracture and foot fracture.Orthopedics department sent a total of 50 fresh tissue specimens from debridement wounds or postoperative incision secretions,and 54 pathogenic bacteria were detected.Gram-positive bacteria were mainly Staphylococcus aureus and Coagulase negative staphylococci,and Gram-negative bacteria were mainly Escherichia coli,Pseudomonas aeruginosa and Acinetobacter baumannii.Among the isolated pathogens,the top five were Staphylococcus aureus(33.33%),Escherichia coli(25.93%),Acinetobacter baumannii(14.81%),Coagulase negative staphylococci(11.11%)and Pseudomonas aeruginosa(5.56%).Staphylococcus aureus and Coagulase negative Staphylococci were more sensitive to Vancomycin.Escherichia coli and Pseudomonas aeruginosa were highly sensitive to Amikacin,and Acinetobacter baumannii was strongly sensitive to Ceftazidime and Amikacin.Conclusion The fracture infection sites are mostly tibiofibula fracture and foot fracture.Gram-negative bacteria predominate in fresh tissue specimens from debridement wounds or postoperative incision secretions.There are differences in drug resistance among different strains.During medication,it is necessary to attach great importance to bacterial culture,detect pathogens and drug resistance,use antibiotics reasonably and inhibit the formation of drug-resistant bacteria.