烧烫伤患者多重耐药菌感染情况及药敏分析

Analysis of infection and drug sensitivity of multi-drug resistant bacteria in scalded patients

目的 分析烧烫伤患者病房多重耐药菌病原菌分布及耐药性。方法 采集患者创面分泌物、血液、中段尿、痰液、静脉置管等标本并进行细菌培养、分离和鉴定。采用K-B纸片琼脂扩散法和最低抑菌浓度(MIC)法进行药敏试验。采用PCR扩增检测耐甲氧西林金黄色葡萄球菌的耐药基因携带情况。结果 共分离出212株多重耐药菌,其中149株(70.28%)来源于创面分泌物标本,33株(15.57%)来源于血液标本,12株(5.66%)来源于痰液标本,7株(3.30%)来源于中段尿标本,5株(2.36%)来源于静脉置管标本,6株(2.83%)来源于其他标本。212株多重耐药菌中,金黄色葡萄球菌64株,铜绿假单胞菌52株,大肠埃希菌43株,肺炎克雷伯菌11株,鲍曼不动杆菌10株,奇异变形杆菌6株,阴沟杆菌4株,肠球菌1株,其他肠杆菌21株。金黄色葡萄球菌对万古霉素、替考拉宁敏感,对红霉素、环丙沙星、庆大霉素、复方新诺明的耐药率分别为79.69%、56.25%、59.38%和39.06%。铜绿假单胞菌对替加环素的敏感,对环丙沙星、阿米卡星、庆大霉素、美罗培南、亚胺培南的耐药率分别为44.23%、17.31%、59.62%、30.77%和34.62%。大肠埃希菌对替加环素的敏感,对环丙沙星、阿米卡星、庆大霉素、美罗培南、亚胺培南的耐药率分别为58.14%、9.30%、69.77%、39.53%、6.98%和9.30%。64株金黄色葡萄球菌中,58株携带mecA耐药基因,34株携带aac(6′)/aph(2′′)耐药基因,25株携带Aph(3)-Ⅲ耐药基因,44株携带ermA耐药基因,31株携带ermC耐药基因,27株携带tetM耐药基因。结论 本次研究中的多重耐药菌主要分布于创面分泌物标本,主要病原菌为耐甲氧西林金黄色葡萄球菌、多重耐药铜绿假单胞菌、产超广谱β-内酰胺酶大肠埃希菌。万古霉素和替考拉宁对多重耐药阳性菌效果较好,替加环素对多重耐药革兰阴性菌治疗效果较好。但由于副作用较大,不宜用作一线用药。

Objective To analyze the distribution and drug resistance of multi drug resistant bacteria in burn and scald patients’ wards.Method The samples of wound secretion,blood,middle urine,sputum and venous catheterization were collected for bacterial culture,isolation and identification.The K-B disk agar diffusion method and the minimum inhibitory concentration(MIC) method were used for drug sensitivity test.The drug resistance genes of MRSA were detected by PCR amplification.Result There were 212 strains of multidrug-resistant bacteria in this study,of which 149 strains(70.28%) were from wound secretion samples,33 strains(15.57%) were from blood samples,12 strains(5.66%) were from sputum samples,7 strains(3.30%) were from middle urine samples,5 strains(2.36%) were from venous catheter samples,and 6 strains(2.83%) were from other samples.Among the 212 strains of multi drug resistant bacteria,there were 64 strains of S.aureus,52 strains of multi drug resistant P.aeruginosa,43 strains of E.coli,11 strains of K.pneumoniae,10 strains of A.baumannii,6 strains of P.mirabilis,4 strains of lactamase cloacae and 1 strain of enterococcus,and 21 strains of other enterobacteriaceae.The S.aureus to vancomycin and teicoplanin was sensitive,and the resistance to erythromycin,ciprofloxacin,gentamicin and cotrimoxazole were 79.69%,56.25%,59.38% and 39.06% respectively.The P.aeruginosa to tegacyclin was sensitive,and the resistance to ciprofloxacin,amikacin,gentamicin,meropenem and imipenem were 44.23%,17.31%,59.62%,30.77% and 34.62% respectively.The E.coli to tegacyclin was sensitive,and the resistance to ciprofloxacin,amikacin,gentamicin,meropenem and imipenem were 58.14%,9.30%,69.77%,39.53%,6.98% and 9.30% respectively.Among the 64 strains of S.aureus,58 strains carried mecA resistance gene,34 strains carried aac(6′)/aph(2′′) resistance gene,25 strains carried aph(3)-Ⅲ resistance gene,44 strains carried ermA resistance gene,31 strains carried ermC resistance gene and 27 strains carried tetM resistance gene.Conclusion The multidrug-resistant bacteria in this study were mainly distributed in wound secretion samples,among which the top pathogens were S.aureus,P.aeruginosa and E.coli.Vancomycin and teicoplanin had better effect on multidrug-resistant positive bacteria,and tegacyclin had better effect on multidrug-resistant Gram-negative bacteria.However,it is not suitable to be used as a first-line drug because of its large side effects.