骨科患者感染伤口病原菌构成及其耐药性分析

Analysis of Pathogenic Bacteria Composition and Drug Resistance in Wound Infections of Orthopedic Patients

目的:探讨诱发骨科患者伤口部位发生感染的病原菌类型,并对其耐药性进行分析,为临床合理使用抗菌药物提供指导.方法:选取2020年1月-2022年12月安福县人民医院骨科收治的200例伤口部位发生感染的患者为研究对象.采集所有研究对象感染部位的分泌物作为研究标本,并进行分离培养,鉴定病原菌的种类,并对其耐药性进行分析,统计最终检测结果.结果:分离出病原菌共计320株,革兰阳性菌、革兰阴性菌、真菌分别占比44.06%、53.44%、2.50%.革兰阳性菌中,金黄色葡萄球菌对万古霉素的耐药率为0.00%,对利奈唑胺的耐药率为1.61%.苯唑西林、克林霉素、红霉素等药物对金黄色葡萄球菌的耐药率较高,尤其是青霉素,其耐药率达到100.00%;凝固酶阴性葡萄球菌对万古霉素和利奈唑胺的耐药率均为0.00%.凝固酶阴性葡萄球菌对左氧氟沙星、环丙沙星、庆大霉素、苯唑西林、克林霉素、红霉素等药物的耐药率也较高,尤其是青霉素,其耐药率同样达到100.00%.革兰阴性菌中,铜绿假单胞菌对头孢哌酮/舒巴坦、阿米卡星、他唑巴坦、美罗培南、亚胺培南等药物的耐药率相对较低,甚至有些为0.00%,对头孢吡肟、环丙沙星、头孢他啶、左氧氟沙星等药物的耐药率在中等水平,对哌拉西林、氨曲南等药物的耐药率相对较高;大肠埃希菌对头孢哌酮/舒巴坦、他唑巴坦、美罗培南、亚胺培南等药物的耐药率相对较低,对氨苄西林、头孢西丁、头孢唑林等药物的耐药率相对较高;肺炎克雷伯菌对头孢哌酮/舒巴坦、他唑巴坦、美罗培南、亚胺培南等药物的耐药率相对较低,对氨苄西林、头孢西丁、头孢唑林等药物的耐药率相对较高.结论:骨科伤口感染的原因多种多样,引发感染的病原菌也十分复杂.因此,在临床实践中,迅速鉴定病原菌并进行药敏测试至关重要.通过以药敏测试结果为依据,合理选择抗菌药,有助于降低多重耐药菌株的产生,加速患者的康复过程.

Objective:To explore the types of pathogenic bacteria composition and drug resistance in wound infections in orthopedic patients,providing guidance for the rational use of antimicrobial drugs in clinical practice.Methods:A total of 200 patients with wound infections in the orthopedics department of Anfu County People's Hospital from January 2020 to December 2022 were selected for the study.Secretions from the infection sites of all study subjects were collected as research specimens,subjected to isolation and cultivation,identification of pathogenic microorganisms,and analysis of their drug resistance.The final test results were statistically analyzed.Results:320 strains of pathogenic microorganisms were isolated,with Gram-positive bacteria,Gram-negative bacteria,and fungi accounting for 44.06%,53.44%,and 2.50%,respectively.Among Gram-positive bacteria,Staphylococcus aureus had a 0.00%resistance rate to vancomycin and a 1.61%resistance rate to linezolid.Penicillin,clindamycin,erythromycin,and other drugs showed relatively high resistance rates against Staphylococcus aureus,especially penicillin,with a resistance rate of 100.00%.Coagulasenegative staphylococci had a 0.00%resistance rate to both vancomycin and linezolid.For Coagulase-negative staphylococci,resistance rates to levofloxacin,ciprofloxacin,gentamicin,penicillin,clindamycin,erythromycin,and other drugs were also relatively high,especially penicillin,with a resistance rate of 100.00%.Among Gram-negative bacteria,Pseudomonas aeruginosa had relatively low resistance rates to ceftazidime/sulbactam,amikacin,tazobactam/piperacillin,meropenem,and imipenem,some even being 0.00%.Escherichia coli had relatively low resistance rates to ceftazidime/sulbactam,tazobactam/piperacillin,meropenem,and imipenem,but higher resistance rates to ampicillin,cefoxitin,and cephalothin.Klebsiella pneumoniae had relatively low resistance rates to ceftazidime/sulbactam,tazobactam/piperacillin,meropenem,and imipenem,but higher resistance rates to ampicillin,cefoxitin,and cephalothin.Conclusion:The causes of orthopedic wound infections are diverse,and the pathogenic microorganisms involved are complex.Therefore,rapid identification of pathogenic microorganisms and drug sensitivity testing are crucial in clinical practice.Rational selection of antibiotics based on drug sensitivity testing results can help reduce the emergence of multidrug-resistant strains and accelerate the patient'srecovery process.