开胸心脏手术后胸骨骨髓炎菌群分布和耐药性分析

Distribution and drug resistance of pathogens isolated from thoracotomy patients with postoperative sternum osteomyelitis

目的探讨开胸心脏手术后胸骨骨髓炎菌群分布和耐药性。方法回顾性分析2016年2月-2019年10月海南医学院第一附属医院心胸外科收治的开胸心脏手术后胸骨骨髓炎患者121例,在使用抗菌药物之前采集血液标本,VITEK2 Compact细菌鉴定药敏分析仪对细菌进行鉴定和药物敏感性试验。收集并进行数据分析。结果119例标本共培养出病原菌125株,革兰阳性菌68株,占54.40%,革兰阴性菌57例,占45.60%,最常见的病原菌为金黄色葡萄球菌,共34株,占27.20%。金黄色葡萄球菌有31株对青霉素耐药,未出现对万古霉素、利奈唑胺、替考拉宁的耐药。铜绿假单胞菌有7株对亚胺培南耐药,有6株分别对氨苄西林、氨苄西林/舒巴坦钠、头孢唑林、氯霉素耐药。全部患者的抗菌药物平均使用时间为(14.25±3.71)d。121例患者之中,采用多种抗菌药物联合治疗的38例,占31.40%。使用广谱抗菌药物的患者93例,占76.86%。结论本地区开胸心脏手术后胸骨骨髓炎的病原菌以革兰阳性菌为主,其中金黄色葡萄球菌的比例最高,造成感染的主要病原菌的耐药性均较高,在以后的工作中应严格依据药敏试验结果选择合适的抗菌药物以降低病原菌的耐药性。

OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from thoracotomy patients with postoperative sternum osteomyelitis.METHODS A total of 121 patients who underwent thoracotomy and has postoperative sternum osteomyelitis in the First Affiliated Hospital of Hainan Medical College from Feb 2016 to Oct 2019 were retrospectively analyzed.The blood specimens were collected before the use of antibiotics,the isolated pathogens were identified,the drug susceptibility testing was performed by using VITEK2 Compact bacterial identification and drug susceptibility analysis system,and the data were collected and analyzed.RESULTS Totally 125 strains of pathogens were isolated from 119 cases of specimens,68(54.40%)of which were gram-positive bacteria,57(45.60%)were gram-negative bacteria.Staphylococcus aureus was the most common species of pathogen,accounting for 27.20%(34 strains).There were 31 strains of S.aureus that were resistant to penicillin,and there were no strains that were resistant to vancomycin,linezolid or teicoplanin.There were 7 strains of Pseudomonas aeruginosa that were resistant to imipenem and 6 strains that were resistant to ampicillin,ampicillin-sulbactam,cefazolin and chloramphenicol.The average time of use of antibiotics was(14.25±3.71)days.Among the 121 patients,38(31.40%)were treated with combined multidrug therapy,and 93(76.86%)were treated with broad spectrum antibiotics.CONCLUSION The gram-positive bacteria are dominant among the pathogens isolated from the thoracotomy patients with postoperative sternum osteomyelitis,and the S.aureus is the predominant species of pathogen.The major species of pathogens causing the infection are highly drug-resistant.It is necessary to choose appropriate antibiotics based on the result of drug susceptibility testing so as to reduce the drug resistant of the pathogens.