骨科术后切口感染愈合不良患者分泌物病原菌分布及耐药性分析

Analysis of distribution and drug resistance of pathogenic bacteria in secretions of patients with poor healing of incision infection after orthopedic surgery

目的:分析骨科术后切口感染愈合不良患者分泌物病原菌分布及耐药性。方法:选取2021年10月至2023年10月该院收治的284例骨科术后切口感染愈合不良患者进行横断面研究。统计骨科术后切口感染愈合不良患者分泌物病原菌分布情况,分析主要革兰阴性和革兰阳性菌株对不同抗菌药物的耐药性。结果:284例患者共检出337株病原菌,其中革兰阳性菌176株(52.23%),以金黄色葡萄球菌(102株)为主;革兰阴性菌161株(47.77%),以铜绿假单胞菌(43株)为主。金黄色葡萄球菌对青霉素耐药率最高(98.04%),其次是氨苄西林(92.16%)、红霉素(47.06%),对阿米卡星、复方磺胺、环丙沙星、奎奴普丁/达福普汀、利奈唑胺、利福平和妥布霉素耐药率较低(均<10%),对呋喃妥因、甲氧氨苄嘧啶、莫匹罗星、替考拉宁和万古霉素均无耐药性。凝固酶阴性葡萄球菌对青霉素耐药率最高(91.07%),对氨苄西林、阿莫西林/克拉维酸、苯唑西林、红霉素、头孢西丁耐药率较高(均>50.00%),对阿米卡星、呋喃妥因、利奈唑胺、利福平、莫匹罗星、妥布霉素耐药率较低(均<10%),对福普汀、替考拉宁、万古霉素均无耐药性。铜绿假单胞菌对氯霉素、头孢唑林耐药率最高(均为86.05%),其次是氨苄西林、氨苄西林/舒巴坦(均为83.71%),阿莫西林/克拉维酸、复方磺胺(均为76.74%),对阿米卡星、美罗培南、哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、头孢他啶均无耐药性。鲍曼不动杆菌对阿莫西林/克拉维酸、氨曲南耐药率最高(均为100.00%),其次为头孢唑林(84.62%)、氨苄西林(84.62%)、氯霉素(65.38%),对阿米卡星、复方磺胺均无耐药性。大肠埃希菌对氨苄西林、四环素、头孢唑林耐药率最高(均为100.00%),其次为哌拉西林(76.32%)、复方磺胺(73.68%)、头孢噻肟(73.68%)、莫西沙星(63.16%)、左氧氟沙星(63.16%)、庆大霉素(60.53%),对阿米卡星、阿莫西林/克拉维酸、美罗培南、哌拉西林/他唑巴坦、亚胺培南均无耐药性。阴沟肠杆菌对阿莫西林/克拉维酸、氨苄西林、氨苄西林/舒巴坦、头孢唑林耐药率最高(均为100.00%),对美罗培南、哌拉西林/他唑巴坦、亚胺培南均无耐药性。结论:骨科术后切口感染愈合不良患者分泌物病原菌分布以金黄色葡萄球菌与铜绿假单胞菌为主,且对多种常用抗生素耐药。

Objective:To analyze distribution and drug resistance of pathogenic bacteria in secretions of patients with poor healing of incision infection after orthopedic surgery.Methods:A cross-sectional study was conducted on 284 patients with poor healing of incision infection after orthopedic surgery in this hospital from October 2021 to October 2023.The distribution of pathogenic bacteria in the secretions of these patients was statistically analyzed.The drug resistance of main Gram-negative and positive strains to different antibiotics was analyzed.Results:A total of 337 strains of pathogenic bacteria were detected in the 284 patients,including 176 strains of Gram-positive bacteria(52.23%),mainly Staphylococcus aureus(102 strains),and 161 strains(47.77%)of Gram-negative bacteria,mainly Pseudomonas aeruginosa(43 strains).Staphylococcus aureus had the highest resistance to Penicillin(98.04%),followed by Ampicillin(92.16%)and Erythromycin(47.06%);it had lower resistance to Amikacin,Compound sulfanilamide,Ciprofloxacin,Quinupristin/Dalfopristin,Linezolid,Rifampicin,and Tobramycin(all<10%),but had no resistance to Nitrofurantoin,Trimethoprim,Mupirocin,Teicoplanin,and Vancomycin.Coagulase negative staphylococci had the highest resistance to Penicillin(91.07%),higher resistance to Ampicillin,Amoxicillin/Clavulanic acid,Oxacillin,Erythromycin,and Cefoxitin(all>50.00%),lower resistance to Amikacin,Nitrofurantoin,Linezolid,Rifampicin,Mupirocin,and Tobramycin(all<10%),and no resistance to Dalfopristin,Teicoplanin,and Vancomycin.Pseudomonas aeruginosa had the highest resistance to Chloramphenicol and Cefazolin(both 86.05%),followed by Ampicillin and Ampicillin/Sulbactam(both 83.71%),Amoxicillin/Clavulanic acid,and Compound sulfonamide(both 76.74%),and had no resistance to Amikacin,Meropenem,Piperacillin,Piperacillin/tazobactam,Cefepime,and Ceftazidime.Acinetobacter baumannii had the highest resistance to Amoxicillin/Clavulanic acid and Ampicillin(both 100.00%),followed by Cefazolin(84.62%),Ampicillin(84.62%),and Chloramphenicol(65.38%);but it was not resistant to Amikacin and Compound sulfanilamide.Escherichia coli had the highest resistance to Ampicillin,Tetracycline,and Cefazolin(all 100.00%),followed by Piperacillin(76.32%),Compound sulfanilamide(73.68%),Cefotaxime(73.68%),Moxifloxacin(63.16%),Levofloxacin(63.16%),and Gentamicin(60.53%);and it had no resistance to Amikacin,Amoxicillin/Clavulanic acid,Meropenem,Piperacillin/Tazobactam,and Imipenem.Enterobacter cloacae had the highest resistance to Amoxicillin/Clavulanic acid,Ampicillin,Ampicillin/Sulbactam,and Cefazolin(all 100.00%),and was not resistant to Meropenem,Piperacillin/Tazobactam,or Imipenem.Conclusions:The pathogenic bacteria in the secretions of the patients with poor healing of incision infection after orthopedic surgery are mainly Staphylococcus aureus and Pseudomonas aeruginosa,and they have of resistance to various commonly used antibiotics.