烧伤创面病原菌分布和耐药性分析

Analysis of distribution and drug resistance of pathogens of burnpatients

目的通过分析烧伤患者细菌流行病学分布和耐药模式,为抗生素合理使用提供可靠的临床依据。方法回顾性分析2015年1月至2019年12月成都市第二人民医院烧伤整形科收治的396例烧伤患者412份标本(创面分泌物、全血、中段尿、痰液等)。使用API细菌鉴定板条鉴定细菌,纸片扩散(K-B)法进行药敏试验。采用WHONET 5.4软件分析病原菌分布、药敏试验及耐药性进行回顾性分析。结果分离出病原菌518株,其革兰阳性菌273株(52.70%),革兰阴性菌245株(47.30%),检出率最高的3种细菌依次为金黄色葡萄球菌(30.89%)、铜绿假单胞菌(10.23%)、肺炎克雷伯杆菌(7.72%)。特重度烧伤患者所检出的病原菌以革兰阴性菌为主。金黄色葡萄球菌、溶血葡萄球菌及表皮葡萄球菌对万古霉素、利奈唑胺及替加环素均无耐药性。金黄色葡萄球菌对喹诺酮类抗生素的耐药率不足50%,且逐年下降(P<0.05)。铜绿假单胞菌、肺炎克雷伯杆菌、阴沟肠杆菌及大肠埃希菌对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦敏感。鲍曼不动杆菌对大部分抗生素均表现出高耐药性,仅对复合酶类抗生素头孢哌酮/舒巴坦及替加环素保持较低耐药性。结论2015-2019年度,引起烧伤患者感染的病原菌主要为金黄色葡萄球菌、铜绿假单胞菌和肺炎克雷伯杆菌;重度及特重度烧伤患者主要以革兰阴性菌为主;革兰阳性菌的耐药情况有所好转,但革兰阴性菌的耐药问题仍然十分严峻,应加强烧伤患者病原菌监测,合理应用抗菌药物。

Objective To analysis the bacterial epidemiological distribution and drug resistance pattern of burn patients so as to provide a reliable basis for the early treatment and prevention of infection caused by such pathogens.Methods A total of 396 burn patients admitted to our hospital from January 2015 to December 2019 were retrospectively analyzed.Their wounds,whole blood,middle urine and sputum samples were detected for etiology.The bacteria were identified by API bacteria identification strip,and the drug sensitivity was tested by K-B method.WHONET 5.4 software was used to analyze the distribution of pathogens,drug sensitivity test and drug resistance.Results A total of 518 pathogenic bacteria were detected,including 273(52.70%)gram-positive cocci(G+c),245(47.30%)gram-negative cocci(G-c).Three of the most common bacteria were Staphylococcus aureus(30.89%),Pseudomonas aeruginosa(10.23%),Klebsiella pneumoniae(7.72%).The main pathogens of extremely severe burn were G-c.S.aureus,Staphylococcus haemolyticus and Staphylococcus epidermidis were not resistant to vancomycin,linezolid and tegacyclin.The resistance rate of S.aureus to quinolones was less than 50%and decreased year by year(P<0.05).Cefoperazone/sulbactam and piperacillin/tazobactam were very sensitive to the common P.aeruginosa,K.pneumoniae,Enterobacter cloacae and Escherichia coli.Acinetobacter baumannii showed high resistance to most antibiotics,but only to Cefoperazone/sulbactam and tegacyclin.Conclusion The top three pathogens of burn patients are S.aureus,P.aeruginosa and K.pneumoniae.The major pathogens of severe and extra severe burn patients are G-c.The drug resistance of G+c has improved,but the drug resistance of G-c is still very serious.Therefore,it is necessary to strengthen the pathogen monitoring of burn patients and apply antibiotics reasonably.