绍兴某医院烧伤患者创面致病菌的分布及耐药性分析

Distribution and drug resistance of pathogenic bacteria on the wounds of burn patients in one hospital of Shaoxing

目的了解绍兴某医院烧伤患者创面感染的病原菌分布情况及其耐药性,为临床抗菌药物使用提供依据。方法回顾性分析2015—2020年绍兴第二医院烧伤科患者首次创面培养阳性病原菌的分布和药敏结果,并进行统计分析。结果共检出2437株菌株,其中革兰阳性菌1570株(64.42%),主要包括金黄色葡萄球菌(709株)、表皮葡萄球菌(434株)、溶血葡萄球菌(174株)和肠球菌(112株);革兰阴性菌867株(35.58%),主要包括肺炎克雷伯菌(131株)、大肠埃希菌(111株)、阴沟肠杆菌(153株)、铜绿假单胞菌(156株)和鲍曼不动杆菌(101株)。6年间,革兰阴性菌占比呈明显上升趋势(χ^(2)_(趋势)=78.74,P<0.001)。金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌对替加环素、替考拉宁和万古霉素均敏感,对甲氧西林(30.75%、77.19%和90.23%)和青霉素(96.90%、97.93%和95.98%)耐药率均较高。5种主要的革兰阴性菌(肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌、铜绿假单胞菌和鲍曼不动杆菌)对美罗培南、亚胺培南、阿米卡星、头孢吡肟、头孢他啶、妥布霉素、环丙沙星和左氧氟沙星的耐药率均低于30%。2015—2020年间,金黄色葡萄球菌对阿奇霉素、复方磺胺甲噁唑、红霉素、环丙沙星、克林霉素、莫西沙星、庆大霉素和左氧氟沙星的耐药率呈明显下降趋势(χ^(2)_(趋势)=4.75、15.97、5.70、12.77、7.16、8.60、11.27和10.71,P=0.029、<0.001、0.016、<0.001、0.007、0.003、0.001和0.001)。结论该院烧伤患者创面感染最常见的是金黄色葡萄球菌,革兰阴性菌耐药性相对偏低。

Objective To investigate the distribution and drug resistance of pathogenic bacteria on wound infections in burn patients,and provide reference for clinical application of antibiotics.Methods The distribution and drug resistance of the bacteria isolated from the primary wound culture of patients in the Burn Department of Shaoxing Second Hospital from 2015 to 2020 were statistically analyzed.Results A total of 2437 strains of bacteria were detected,including 1570(64.42%)strains of gram-positive bacteria,mainly including 709 S.aureus,434 S.epidermis,174 S.haemolyticus and 112 Enterococcus.A total of 867(35.58%)strains of gram-negative bacteria were detected,mainly including 131 K.pneumoniae,111 E.coli,153 E.cloacae,156 P.aeruginosa and 101 A.baumannii.The proportion of gram-negative bacteria increased significantly during 6 years(χ^(2)_(trend)=78.74,P<0.001).The main gram-positive bacteria(S.aureus,S.epidermidis and S.haemolyticus)were all sensitive to tigecycline,teicoranin and vancomycin,and were highly resistant to methicillin(30.75%,77.19%and 90.23%)and penicillin(96.90%,97.93%and 95.98%).The resistance rates of five major gram-negative bacteria(K.pneumoniae,E.coli,E.cloacae,P.aeruginosa and A.baumannii)to meropenem,imipenem,amikacin,cefepime,ceftazidime,tobramycin,ciprofloxacin and levofloxacin were lower than 30%.The drug resistance rates of S.aureus to azithromycin,compound minophen,erythromycin,ciprofloxacin,clindamycin,moxifloxacin,gentamicin and levofloxacin showed significant downward trend during 2015 and 2020(χ^(2)_(trend)=4.75,15.97,5.70,12.77,7.16,8.60,11.27 and 10.71,P=0.029,<0.001,0.016,<0.001,0.007,0.003,0.001 and 0.001).Conclusions S.aureus is the common pathogenic bacteria isolated from the wound surface of the burn patients in this hospital.The drug resistance of gram-negative bacteria is relatively low.