血管外科下肢溃疡感染病原学特点及耐药性分析

Pathogenic characteristics and drug resistance of lower extremity ulcer infection in vascular surgery

目的:分析比较血管外科常见下肢静脉性、动脉性溃疡感染的病原学特点及耐药性,为制订合理有效的抗感染方案提供依据。方法:选取2015年7月-2020年7月苏州大学附属第二医院血管外科180例下肢溃疡感染患者(分泌物培养阳性),根据病因分为2组,A组为静脉性溃疡,共114例;B组为动脉性溃疡,共66例,采集创口分泌物相关样本进行病原菌培养鉴定及药敏试验,分析比较病原学特点及耐药性。结果:180例患者中共检出236株病原菌,其中,革兰阳性菌123株,占52.12%,革兰阴性菌113株,占47.88%。A、B 2组革兰阳性菌检出率分别为52.08%、52.17%,革兰阴性菌检出率分别为47.92%、47.83%。革兰阳性菌中,A组以金黄色葡萄球菌、表皮葡萄球菌为主,对青霉素G、氨苄西林、红霉素、克林霉素的耐药率较高,对左旋氧氟沙星、庆大霉素的耐药率较低。B组以金黄色葡萄球菌、粪肠球菌为主,粪肠球菌对喹奴普汀/达福普汀、利福平、红霉素、庆大霉素的耐药率较高,对左旋氧氟沙星、环丙沙星的耐药率较低。革兰阴性菌中,A组以铜绿假单胞菌、大肠埃希菌为主,对氨苄西林、四环素、头孢唑林、头孢噻肟的耐药率较高,对头孢他啶、亚胺培南的耐药率较低。B组以阴沟肠杆菌、黏质沙雷菌为主,对阿莫西林克拉维酸、氨苄西林、头孢唑林、头孢西丁、头孢呋辛的耐药率较高,对头孢他啶、头孢吡肟、亚胺培南、左旋氧氟沙星的耐药率较低。结论:静脉性溃疡和动脉性溃疡患者感染的病原菌中,革兰阳性菌均多于革兰阴性菌,但两类患者感染的主要病原菌种类及占比有所不同,这些病原菌对多种抗菌药物具有较高耐药性,临床上应选择敏感性药物进行抗感染治疗。

OBJECTIVE To compare the pathogenic characteristics and drug resistance of venous and arterial ulcer infections of lower limbs during vascular surgery so as to provide rationales for formulating a reasonable and effective anti infective regimen.METHODS From July 2015 to July 2020, a total of 180 patients with lower extremity ulcer infection(positive secretion Culture) were recruited and divided into two groups of venous ulcers(A, n=114) and arterial ulcers(B, n=66). according to the etiology. Samples related with wound secretions were collected for the identification of pathogenic bacteria culture and drug susceptibility testing and the pathogenic characteristics and drug resistance compared.RESULTS A total of 236 pathogenic bacteria were detected, including 123 Gram-positive isolates(52.12%) and Gram-negative 113 isolates(47.88%). The detection rates of Gram-positive/negative bacteria were 52.08%, 52.17% in group A and 47.92%, 47.83% in group B. Among Gram-positive bacteria, group A was dominated by Staphylococcus aureus and Staphylococcus epidermidis and showed a high resistance to penicillin G, ampicillin, erythromycin and clindamycin and a low resistance to levofloxacin and gentamicin. Group B was dominated by Staphylococcus aureus and Enterococcus faecalis. It showed a high resistance to quinupramine/dalfopristine, rifampicin, erythromycin, gentamicin and a low resistance to levofloxacin and ciprofloxacin. Among Gram-negative bacteria, Pseudomonas aeruginosa and Escherichia coli were the predominant bacteria in group A. It showed a high resistance to ampicillin, tetracycline, cefazolin and cefotaxime and a low resistance to ceftazidime and imipenem. Group B was dominated by Enterobacter cloacae and Serratia marcescens and it showed a high resistance to amoxicillin/clavulanate, ampicillin, cefazolin, cefoxitin, cefuroxime and to a lesser extent to ceftazidime, cefepime, imipenem and levofloxacin.CONCLUSION Among the pathogens in patients with venous and arterial ulcers, there are more Gram-positive bacteria than Gram-negative counterpart. However, the predominant pathogen species and the proportion of infected pathogens in two types of patients are different. These pathogens have a high resistance to a variety of antimicrobial agents so that sensitive drugs should be selected for anti infective treatment in clinical practices.