慢性感染性难愈合创面病原菌分布与药物敏感性及相关危险因素分析

Analysis of the Distribution Characteristics and Drug Sensitivity of Pathogenic Bacteria in Chronic Infectious Hard-to-heal Wounds,and Their Relevant Risk Factors

目的回顾性分析慢性感染性难愈合创面病原菌分布特点、药物敏感性及相关危险因素。方法选取2016年10月至2018年12月南京大学医学院附属南京鼓楼医院收治的183例慢性难愈合创面患者作为研究对象,分析感染性创面病原菌分布特点、主要病原菌药物敏感情况及创面感染的相关危险因素。结果183例患者经创面病原菌检测,创面存在感染者150例,设为感染组;创面无感染者33例,设为非感染组。感染组150例患者共采集标本180份,均为阳性,分离培养出病原菌33种,其中革兰氏阴性菌占59.4%、革兰氏阳性菌占38.3%、真菌占2.3%。主要革兰氏阴性菌中铜绿假单胞菌对丁胺卡那、妥布霉素敏感率较高,鲍曼不动杆菌对多粘菌素B敏感率较高,大肠埃希菌对哌拉西林舒巴坦、头孢替坦、头孢他啶、厄他培南、亚胺培南敏感率较高,奇异变形杆菌对大部分抗菌药物较敏感,而肺炎克雷伯杆菌对大部分抗菌药物敏感性较低。主要革兰氏阳性菌中金黄色葡萄球菌对青霉素、红霉素、克林霉素敏感率普遍较低,耐甲氧西林金黄色葡萄球菌对喹努普汀/达福普汀、利奈唑胺、万古霉素、替加环素、利福平、复方新诺明敏感率较高,肠球菌属对青霉素、氨苄西林敏感率较高,链球菌属对检验药物敏感率均较高。多因素Logistic回归分析结果显示,创面深达皮肤深层及长期卧床是慢性感染性难愈合创面的独立危险因素(P均<0.05)。结论铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌是慢性难愈合创面感染的主要致病菌,且对各种抗生素敏感率差异较大;创面深达皮肤深层、长期卧床是创面感染的独立危险因素,早期合理应用抗菌药物、提前对危险因素进行干预是控制慢性难愈合创面感染的必要措施。

Objective To analyze retrospectively the distribution characteristics and drug sensitivity of pathogenic bacteria in chronic infectious hard-to-heal wounds,and the relevant risk factors of such wounds.Methods 183 patients with chronic hard-to-heal wounds,admitted into Nanjing Drum Tower Hospital between October 2016 and December 2018,were selected as study subjects to analyze the distribution characteristics and drug sensitivity to major antibacterial agents of pathogenic bacteria,and relevant risk factors of wound infection.Results Based on the detection of pathogenic bacteria,150 patients out of the 183 patients were patients with infectious wounds,being set as the infection group,and the left 33 patients were without wound infection,being set as the non-infection group.In the infection group,a total of 180 specimens were collected from the 150 patients,and were all bacteria-positive.A total of 33 strains of pathogens were isolated from the specimens,of which Gram-negative bacteria accounted for 59.4%,Gram-positive bacteria 38.3%and fungi 2.3%.Among the major Gram-negative bacteria,Pseudomonas aeruginosa had a much high sensitivity to Amikacin and Tobramycin,Acinetobacter baumannii presented a high sensitivity to Polymixin B,Escherichia coli was very sensitive to Piperacillin Sodium and Sulbactam Sodium,Cefotetan,Ceftazidime,Ertapenem and Imipenem,Proteus mirabilis was much sensitive to majority of antibacterial agents,while Klebsiella pneumoniae was less sensitive to most antibacterial agents.Among the major Grampositive bacteria,Staphylococcus aureus was generally insensitive to Penicillin,Erythromycin and Clindamycin,Methicillinresistant Staphylococcus aureus(MRSA)had a much high sensitivity to Quinupristin/Dalfopristin,Linezolid,Vancomycin,Tigecycline,Rifampicin and Compound Sulfamethoxazole,Enterococcus was very sensitive to Penicillin and Ampicillin,and Streptococcus had a much high sensitivity to the antibacterial agents used in the study.The results of multi-factor Logistic regression analysis showed that wound depth to deep skin layer and bedridden history were the independent risk factors of chronic infectious hard-to-heal wounds(bothP<0.05).Conclusion Pseudomonas aeruginosa,Acinetobacter baumannii and Staphylococcus aureus are the main pathogenic bacteria of chronic hard-to-heal wounds complicated with infection,and they varies greatly in drug sensitivity to antibacterial agents.Wound depth to deep skin layer and long-time bedridden history are two independent risk factors of wound infection.Early and proper application of antibacterial agents and early intervention on risk factors are necessary measures to control infection of chronic hard-to-heal wounds.