Analysis and control of multidrug-resistant bacteria in hospital

Objective:To investigate the status of multidrug-resistant bacteria and the prevention and control measures of nosocomial in-fection in our hospital.Methods:The annual monitoring of multidrug-resistant bacteria infection was measured to summarize the bacteria species,statistical distribution and antibiotic resistance.Identification of multidrug-resistant bacteria infection in patients infected or hospital acquired infections was taken to analyze the reasons of multidrug-resistant bacteria strain and put forward the relevant measures.Results:The top five of multidrug-resistant strains infections were:Gram-positive bacteria including methicillin-resistant Staphylococcus aureus,Staphylococcus aureus;Gram-negative bacteria including Escherichia coli,Acinetobacter bauman-nii,Klebsiella pneumoniae.Conclusions:The occurrence of multidrug-resistant hospital infections could be prevented by rational use of antibiotics,hand hygiene and disinfection management,and reinforced monitoring of multidrug-resistant bacteria.

Yolk–shell Au@carbon nanospheres with photothermal and electronplunder sterilization for infected wound healing

Highly pathogenic-resistant bacteria infectionsseriously hinder the wound healing process and induce a catastrophic threat to human health. Incorporating multipleantibacterial strategies into nanostructured materials has beenverified to possess paramount promise for amelioratingtherapeutic efficiency against resistant bacteria. Herein, amultifunctional yolk–shell nanocomposite (Au@HCN) comprised of an aurum (Au) core and hollow carbon nanosphere(HCN) shell was prepared via one-step copolymerization andcarbonization. The electron plunder by Au@HCN on thebacterial membrane leads to bacterial membrane depolarization and enhanced reactive oxygen species (ROS) metabolism,resulting in remarkable efficacy against drug-resistant bacteriaunder dark conditions. Moreover, the synergetic photothermaltherapy (PTT) displayed significant antibacterial properties(~98%) when exposed to near-infrared (NIR) irradiation invitro. Meanwhile, efficient eradication of drug-resistant bacteria in the infected wound in vivo was observed under NIRexposure, thereby promoting wound healing through theprominent antibacterial properties of Au@HCN. The yolk–shell Au@HCN possesses tremendous potential for combatingmultidrug resistance with high efficiency.

Copper ion/gallic acid MOFs-laden adhesive pomelo peel sponge effectively treats biofilm-infected skin wounds and improves healing quality

Bacterial infection and scar formation remain primary challenges in wound healing.To address these issues,we developed a decellularized pomelo peel(DPP)functionalized with an adhesive PVA-TSPBA hydrogel and antibacterial gallic acid/copper MOFs.The hybrid wound dressing demonstrates favorable biocompatibility.It does not impede the proliferation of fibroblasts or immune cells and can stimulate fibroblast migration,endothelial angiogenesis,and M2 macrophage polarization.Additionally,the dressing can scavenge reactive oxygen species(ROS)and provide antioxidant effects.Furthermore,DPP+MOF@Gel effectively inhibits the viability of S.aureus and E.coli in vitro and in vivo.The histological observations revealed enhanced granulation tissue formation,re-epithelialization,and angiogenesis in the DPP+MOF@Gel group compared to other groups.The local immune response also shifted from a pro-inflammatory to a pro-regenerative status with DPP+MOF@Gel treatment.The skin incision stitching experiment further exhibits DPP+MOF@Gel could reduce scar formation during wound healing.Taken together,the hybrid DPP+MOF@Gel holds great promise for treating bacteria-infected skin wounds and inhibiting scar formation during wound healing.

Wrapping collagen-based nanoparticle with macrophage membrane for treating multidrug-resistant bacterial infection

Nowadays,multidrug-resistant(MDR)bacterial infectious diseases has become a thorny issue in the healthcare field.Owning to its intrinsic merits,photodynamic therapy(PDT)shows tremendous strengths in fighting against MDR bacterial infections.However,most photodynamic nanoplatforms exhibit unsatisfactory targeting efficiency towards bacteria and infection site,which may compromise the bactericidal effect of PDT.Herein,we firstly reported a bacteria-targeted collagen-based nanoparticle,named Ce6/Col/MM,for treating methicillin-resistant Staphylococ-cus aureus(MRSA)-infected wound.Ce6/Col/MM was fabricated by wrapping chlorin e6(Ce6)-loaded collagen-based nanoparticles with macrophage membrane(MM),showing excellent photodynamic activity and good biocompat-ibility.In vitro studies demonstrated that Ce6/Col/MM could target to bacteria and then exhibit prominent antibacterial capacity against planktonic MRSA under light irradiation.Furthermore,the treatment of MRSA-infected wound in mice with Ce6/Col/MM plus light illumination resulted in potent bacterial inactivation and accelerated wound healing,accompanied by favorable histological compatibility.Collectively,Ce6/Col/MM with superior targeting ability towards bacteria,effective photodynamic antibacterial potency and minimal safety concerns,might be a powerful bactericidal nanoagent for treating infections caused by MDR bacteria。

Bacteriological profile of burn wound isolates in a burns center of a tertiary hospital

Objective:To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates.Methods:Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU) from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity.Results:A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3%) and females 35 (40.7%). Age of participants ranged from 0–56+ years.Pseudomonas aeruginosawas the commonest pathogen isolated 26(30.2%), followed byPseudomonas spp. 21(24.4%),Escherichia coli 17(19.8%),Klebsiellaspp. 12(14.0%). Coagulase negativeStaphylococcusaccounted for 2(2.3%). Overall prevalence of infection in the study was 90.7%.Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.

重症监护病房压力性损伤患者伤口感染的致病菌及危险因素分析

目的探讨重症监护病房压力性损伤(PI)患者的伤口感染致病菌分布及危险因素。方法回顾性分析在我院重症监护病房住院期间发生PI的189例患者的临床资料,统计患者伤口感染发生情况及其致病菌种类,分析导致患者发生伤口感染的危险因素。结果重症监护病房189例PI患者中,有32例(16.93%)发生了伤口感染。伤口分泌物标本中共分离出病原菌48株,革兰氏阳性菌、革兰氏阴性菌及真菌分别有19株(39.58%)、27株(56.25%)和2株(4.17%)。年龄≥70岁、创面分期3~4期、合并组织水肿、合并糖尿病、血浆白蛋白水平<30 g/L、PI持续时间≥1个月及大小便失禁是PI患者发生伤口感染的危险因素(OR>1,P<0.05),而加用中药敷料及有自主翻身能力是避免发生伤口感染的保护性因素(OR<1,P<0.05)。结论重症监护病房PI患者伤口感染中革兰氏阴性菌检出率较高,年龄越大、创面分期3~4期、合并组织水肿、合并糖尿病、血浆白蛋白水平较低、PI持续时间较长、大小便失禁的PI患者越容易出现伤口感染,因此,临床可使用针对性的抗生素,加用中药敷料,协助患者勤翻身等,以减少PI伤口感染。

负压引流辅助治疗骨与软组织感染的机制

背景:随着国内人口老龄化进程的加快,骨与软组织感染的发病率也随之升高。骨与软组织感染可累及包括骨膜、骨皮质、骨松质和骨髓在内的所有骨组织及周围软组织,如糖尿病足、骨髓炎、手术切口感染和关节假体周围感染等均属此范畴,由于其发病机制复杂且治疗困难,因而越来越受到临床关注。负压创面治疗技术是近年来用于伤口治疗的新兴技术,尤其在骨与软组织感染领域疗效显著。目的:综述近年国内外负压创面治疗技术治疗骨与软组织感染的研究进展。方法:检索1990-2022年在PubMed、Web of Science数据库和中国知网发表的相关中英文文献,英文检索词“negative pressure wound therapy,vacuum assisted closure,negative pressure,osteomyelitis,bone infection”;中文检索词“负压伤口疗法,局部负压疗法,负压包扎,负压封闭技术,机械力,骨髓炎,骨感染”。共检索到711篇相关文献,其中65篇文献符合纳入标准。结果与结论:①负压创面治疗技术作为一种创面辅助治疗方式,相对于单一作用的传统敷料,其稳定创面、减轻水肿、降低细菌载荷、刺激肉芽组织和血管生成、改善组织灌注、调控末梢神经、调节生物免疫、促进成骨细胞增殖和分化的多重作用机制,能够更好地管理骨与软组织感染等复杂创面;②现有的大量基础及临床研究结果表明负压创面治疗技术在辅助治疗骨与软组织感染中具有显著的安全性及有效性。

Bacterial Infections in Acute-on-chronic Liver Failure:Epidemiology,Diagnosis,Pathogenesis,and Management

Acute-on-chronic liver failure(ACLF)is a distinct condition characterized by the abrupt exacerbation of pre-existing chronic liver disease,often leading to multi-organ failures and significant short-term mortalities.Bacterial infection is one of the most frequent triggers for ACLF and a common complication following its onset.The impact of bacterial infections on the clinical course and outcome of ACLF underscores their critical role in the pathogenesis of systemic inflammation and organ failures.In addition,the evolving epidemiology and increasing prevalence of multidrug-resistant bacteria in cirrhosis and ACLF highlight the importance of appropriate empirical antibiotic use,as well as accurate and prompt microbiological diagnosis.This review provided an update on recent advances in the epidemiology,diagnosis,pathogenesis,and management of bacterial infections in ACLF.

Efficient elimination of multidrug-resistant bacteria using copper sulfide nanozymes anchored to graphene oxide nanosheets

Antibacterial nanomaterials have attracted growing interest for bacterial infection therapy.However,most nanomaterials eliminate bacteria either physically or chemically,which hampers their efficacy when dealing with multidrug-resistant bacteria.To overcome this,we integrated copper sulfide(CuS)nanoparticles with active graphene oxide nanosheets(GO NSs)to synthesize a superior nanocomposite(CuS/GO NC)that acts both physically and chemically on the bacteria.CuS/GO NC was produced using a facile hydrothermal method,whereby the CuS nanoparticles grew and were uniformly dispersed on the GO NSs in situ.We found that the CuS/GO NC possesses a unique needle-like morphology that physically damages the bacterial cell membrane.CuS/GO NC also exhibits high oxidase-and peroxidase-like activity,ensuring efficient generation of the reactive oxygen species•OH from H2O2,which kills bacteria chemically.These features endow the CuS/GO NC with excellent antibacterial capabilities to kill multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus(MRSA)with only a single dose.Additionally,it was found that the CuS/GO NC accelerated the healing of infected wounds in vivo owing to its good biocompatibility as well as facilitation of cell migration and collagen secretion.This study provides a new strategy to combine the physical and chemical antibacterial modes of nanomaterials to develop more effective therapies to combat multidrug-resistant bacterial infections.

复方黄柏液联合磺胺嘧啶银乳膏对烧伤合并多重耐药菌创面感染患者创面愈合及炎性因子的影响

目的探讨复方黄柏液联合磺胺嘧啶银乳膏对烧伤合并多重耐药菌(MDROS)创面感染患者创面愈合及炎性因子的影响。方法选取2019年7月—2022年1月本院收治的86例烧伤合并MDROS创面感染患者,采用数字奇偶法分为对照组(给予磺胺嘧啶银乳膏治疗)和观察组(给予复方黄柏液联合磺胺嘧啶银乳膏治疗),每组各43例。比较2组患者创面中医症状评分、创面面积、创面愈合率、炎性因子[降钙素原(PCT)、C反应蛋白(CRP)]水平、创面分泌物细菌培养结果和不良反应。结果治疗后观察组主症、次症评分及总分均低于对照组(P<0.05),观察组总有效率高于对照组(P<0.05);治疗后观察组创面面积低于对照组(P<0.05),观察组创面愈合率高于对照组(P<0.05);治疗后观察组PCT和CRP水平均低于对照组(均P<0.05);治疗后观察组革兰阳性菌、革兰阴性菌感染病例数低于对照组(P<0.05);2组不良反应发生率相近(P>0.05)。结论烧伤合并MDROS创面感染患者采用复方黄柏液、磺胺嘧啶银乳膏联合治疗有利于促进创面愈合,降低炎性因子水平,控制创面细菌感染,缓解临床症状,提高临床疗效,且安全可靠。

创面感染病原菌分布及对常用抗菌药物敏感性分析

目的:分析创面感染病原菌分布及对常用抗菌药物的敏感性,从而为创面感染的治疗选择更加安全高效的抗菌药物,保障治疗效果。方法:选择2021年1月—2022年12月荆州市第三人民医院收治的292例创面感染患者纳入研究,应用Levin法采集患者的伤口分泌物,并将采集的标本转送至微生物室做分泌物培养+药敏试验,统计分析患者病原微生物分布及抗菌药物敏感性。结果:共培养出236株病原微生物,其中有82株革兰阳性菌,占总数34.75%;150株革兰阴性菌,占总数的63.56%;念珠菌4株,占总数的1.69%。药敏检测结果显示,金黄色葡萄球菌、表皮葡萄球菌对万古霉素、利奈唑胺、利福平的敏感性较高,对青霉素、红霉素、克林霉素的敏感性偏低。大肠埃希菌对亚胺培南、头孢吡肟、哌拉西林/他唑巴坦敏感性较高,对头孢曲松、左氧氟沙星、头孢他啶、庆大霉素的敏感性偏低;肺炎克雷伯菌对亚胺培南、头孢吡肟、阿米卡星敏感性较高,对头孢曲松、头孢他啶、庆大霉素的敏感性偏低;铜绿假单胞菌对亚胺培南、哌拉西林/他唑巴坦敏感性较高,对头孢曲松、头孢他啶、庆大霉素的敏感性偏低。结论:创面感染患者的病原菌种类较多,不同类型的抗生素对病原菌敏感性各不相同,临床应加强病原菌药敏试验,并根据具体情况可选择联合用药方式,以提升感染治疗效果。

外伤感染患者伤口分泌物病原菌分布及耐药性分析

目的:分析外伤感染患者伤口分泌物病原菌分布及耐药性。方法:回顾性分析2020年3月至2022年9月该院收治的210例外伤感染患者的临床资料,采集伤口分泌物进行病原菌培养和药敏试验,分析外伤感染患者伤口分泌物病原菌分布情况及耐药性。结果:210例外伤感染患者伤口分泌物标本共检出246株病原菌,其中革兰阴性菌147株,革兰阳性菌78株,真菌21株;革兰阴性菌以大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌为主;革兰阳性菌以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主;大肠埃希菌对氨苄西林的耐药率最高(87.50%),对亚胺培南、美罗培南均不耐药;铜绿假单胞菌对复方磺胺甲噁唑、米诺环素的耐药率最高(均为100.00%),对左氧氟沙星、头孢他啶、头孢吡肟、亚胺培南、美罗培南的耐药率较低(均<15%);阴沟肠杆菌对氨苄西林的耐药率最高(100.00%),对头孢哌酮、亚胺培南、美罗培南均不耐药;金黄色葡萄球菌、凝固酶阴性葡萄球菌对四环素的耐药率最高(均为100.00%),对万古霉素、替考拉宁、利奈唑胺均不耐药。结论:外伤感染患者伤口分泌物病原菌分布以革兰阴性菌为主,其中大肠埃希菌占比最高,对氨苄西林的耐药率最高。

血清SAA、CRP、HSP70、PCT水平对脊柱手术切口深部感染的预测分析

目的分析血清淀粉样蛋白A(SAA)、C反应蛋白(CRP)、热休克蛋白70(HSP70)、降钙素原(PCT)水平对脊柱手术切口深部感染的预测价值。方法选取2018年5月至2020年12月在该院接受脊柱手术治疗的395例患者,根据术后切口深部感染发生情况将患者分为感染组、未感染组。两组均应用免疫比浊法检测血清SAA水平,酶联免疫吸附实验检测血清CRP、HSP70水平,电化学发光法检测血清PCT水平;分析患者术后切口深部感染发生情况,比较感染组、未感染组术后24 h血清SAA、CRP、HSP70、PCT水平,并采用受试者工作特征(ROC)曲线分析血清SAA、CRP、HSP70、PCT水平单项及联合检测对脊柱手术切口深部感染的预测价值。结果接受脊柱手术治疗的395例患者术后切口感染发生率为5.82%,细菌培养共分离出45株病原菌(革兰阳性菌12株、革兰阴性菌31株、真菌2株);感染组与未感染组相比,术后24 h血清SAA、CRP、HSP70、PCT水平均较高(P<0.05),两组间其余资料比较差异无统计学意义(P>0.05);血清SAA、CRP、HSP70、PCT水平联合预测感染组切口深部感染的灵敏度、特异度、曲线下面积分别为100.00%、91.38%、0.992,灵敏度和AUC均高于单独预测(α<0.02),特异度与单独预测差异无统计学意义(P>0.05)。结论脊柱手术术后发生切口深部感染患者感染发生率为5.82%,病原菌主要为革兰阳性菌、革兰阴性菌和真菌,感染组的术后24 h血清SAA、CRP、HSP70、PCT水平均较未发生切口深部感染患者高,血清SAA、CRP、HSP70、PCT水平均对患者术后切口深部感染具有一定的预测作用,但以四者联合检测时的预测效能更佳。

慢性伤口感染常见病原菌及其干预效果研究

目的探讨慢性伤口常见病原菌种类、阳性率及其分布对伤口愈合的影响,分析含银敷料对不同种类病原菌的干预效果及其有效作用时间,为临床有效护理伤口提供依据。方法对入选的178例慢性伤口按照统一方法评估、清洗伤口和清创,含银敷料覆盖或填充,隔日处理1次,连续干预28d,随访3个月。结果干预前检出致病菌阳性率和耐药菌阳性率分别为76.40%和67.42%,病原菌10种,排序前3的依次为金黄色葡萄球菌（31.46%）、铜绿假单胞菌（13.48%）和大肠杆菌（8.43%）。含银敷料干预后7d病原菌阳性率有不同程度下降,干预14d和28d阳性率进一步下降,以大肠杆菌和金黄色葡萄球菌下降最明显。干预后14d伤口面积缩小,干预后7d疼痛计分下降,干预28d面积缩小和疼痛减轻最明显。干预期内和随访期内愈合率分别为18.54%（33例）和87.08%（155例）。结论慢性伤口中存在高阳性率的病原菌,影响伤口愈合。含银敷料对不同细菌抑菌效果存在差异性,至少连续使用2～4周才能奏效。临床需结合伤口类型、细菌种类等综合分析,动态调整,合理使用含银敷料。

Mohnarin 2009年度报告:伤口感染细菌的耐药性监测

目的了解2009年度全国114家三级甲等医院中临床伤口感染患者细菌分布情况及对各类抗生素的耐药状况。方法药物敏感试验,用纸片法、MIC法或E-test法;耐药性数据用WHONET 5.5软件进行统计分析。结果共分离菌株6171株,其中革兰阳性菌2728株(44.2%),革兰阴性菌3443株(55.8%);分离率最高的前6位病原菌依次为金黄色葡萄球菌(19.8%)、大肠埃希菌(16.9%)、铜绿假单胞菌(8.9%)、肺炎克雷伯菌(8.0%)、表皮葡萄球菌(6.7%)及鲍曼不动杆菌(5.2%)。耐甲氧西林金黄色葡萄球菌、表皮葡萄球菌检出率分别为31.0%与65.1%;未发现对万古霉素和利奈唑胺中介或耐药葡萄球菌;表皮葡萄球菌对替考拉宁有1.2%的中介率。屎肠球菌对抗菌药物的整体耐药性明显高于粪肠球菌,对万古霉素耐药的粪肠球菌和屎肠球菌分别占0.5%和1.5%;屎肠球菌对替考拉宁的耐药率为1.3%;未发现利奈唑胺耐药的肠球菌。大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶(ESBLs)检出率分别为65.5%和40.0%;大肠埃希菌对抗菌药物的整体耐药性,高于肺炎克雷伯菌;鲍曼不动杆菌对大多数监测药物敏感率低于43%;铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为17.2%,33.8%。结论我国临床患者伤口感染致病菌以葡萄球菌、大肠埃希菌、铜绿假单胞菌为主;细菌耐药严重,应定期进行耐药性监测。

慢性伤口癌变筛查结果分析及干预方法的初步探讨

目的慢性伤口长期反复感染增加处理难度和癌变风险。文中旨在探讨慢性伤口癌变筛查方法、临床特征及干预方法,为临床及早发现和有效干预提供依据。方法入选2010年1月至2014年8月在南京军区南京总医院初诊为慢性伤口患者共358例,分为手术治疗组(n=78)和非手术治疗组(n=280),2组均包扎伤口使用银敷料抗感染,全身采用口入营养食谱、心理调适等整体干预方案,前者实施病灶切除和转皮瓣手术,2组干预观察期均为从伤口处理开始至第9周。观察指标包括癌变检出率、致病菌阳性率、癌变伤口愈合率等。结果 358例患者癌变检出率为6.70%,癌变伤口患者的持续时间中位数为352.50 d,癌变伤口类型构成比分别为不典型伤口(58.33%)、切口难愈(25%)、压疮(8.33%)、静脉性溃疡(4.17%)、外伤溃疡(4.17%)。致病菌阳性率67.32%,2组患者干预期内无死亡,伤口总愈合率差异无统计学意义(P=0.187),但手术治疗组癌变伤口愈合率高于非手术治疗组(75.00%vs 37.50%,P=0.040)。结论长期感染是诱发慢性伤口癌变的可能原因,手术治疗是癌变伤口和引流不畅深部伤口的有效干预手段,非手术治疗是癌变伤口姑息治疗的可选方法和大部分未癌变伤口的有效干预方法。

烧伤患者创面感染病原菌分布及耐药性监测

目的分析烧伤患者病原菌分布及其耐药性,为临床合理使用抗菌药物提供依据。方法选取2014年1月-2015年12月新疆维吾尔自治区人民医院烧伤科123例烧伤患者,收集创面分泌物中分离的病原菌,采用K-B纸片扩散法进行药敏试验,并分析主要致病菌的耐药性。结果 123例患者共分离出174株病原菌,其中革兰阳性菌67株(38.5%),革兰阴性菌103株(59.2%),真菌4株(2.3%);金黄色葡萄球菌对青霉素、红霉素、复方新诺明、克林霉素等药物耐药率分别为92.2%、68.6%、58.8%、54.9%,对万古霉素、利奈唑胺、氨苄西林/舒巴坦100%敏感;鲍氏不动杆菌对头孢曲松、氨曲南、哌拉西林、哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、环丙沙星等药物耐药率分别为100%、100%、87%、87%、82.6%、82.6%、82.6%,对头孢西丁、氯霉素100%敏感;大肠埃希菌对哌拉西林、头孢曲松、复方新诺明、环丙沙星、左氧氟沙星等药物耐药率分别为85.7%、76.2%、76.2%、71.4%、61.9%,对阿米卡星、亚胺培南、美罗培南、氯霉素100%敏感。结论烧伤患者创面感染以金黄色葡萄球菌和鲍氏不动杆菌为主,治疗时应进行药敏试验,根据药敏试验的结果合理使用抗菌药物。

负压封闭引流创面冲洗频次对堵管及细菌清除率的影响

目的探讨负压封闭引流治疗新鲜创面和感染创面的最佳冲洗频次,以防范堵管,促进创面愈合。方法选择167例(180处创面)行创面生理盐水负压封闭引流术患者,将其中90处新鲜创面随机分为不冲洗组30处,隔日冲洗组30处,每日冲洗组30处;90处感染创面随机分为每日冲洗1次组30处,每日冲洗2次组30处,每日冲洗3次组30处,观察堵管率和创面细菌清除率。结果新鲜创面:隔日冲洗组和每日冲洗组均未发生堵管,不冲洗组堵管率26.67%;三组不同干预时间创面细菌计数比较,干预主效应、时间效应和交互效应差异有统计学意义(均P<0.01),细菌清除率隔日冲洗(98.79%)和每日冲洗组(99.17%)高于不冲洗组(90.79%)。感染创面:三组堵管率比较差异有统计学意义(P<0.05);三组不同干预时间创面细菌计数比较,干预主效应、时间效应和交互效应差异有统计学意义(均P<0.01);细菌清除率每日冲洗2次组(99.34%)和每日冲洗3次组(99.49%)高于每日冲洗1次组(94.62%)。结论新鲜创面选择隔日冲洗、感染创面选择每日冲洗2次,可有效减少堵管发生率,保证持续负压治疗的有效性,且相对经济、节约护理人力。

不同烧伤面积患者创面感染病原菌分布及其耐药性

目的调查分析不同烧伤面积患者创面感染病原菌分布特点及其耐药情况,为临床合理使用抗菌药物提供参考。方法调查2015—2020年北京积水潭医院收治的烧伤患者创面感染的细菌培养结果,根据患者烧伤面积与体表面积比例的不同,分为<10%烧伤面积占总体表面积(TBSA)、10%~49%TBSA和≥50%TBSA 3组,分析不同烧伤面积下创面感染的病原菌分布特点,测定抗菌药物对主要病原菌的最低抑菌浓度,采用χ^(2)检验比较不同烧伤面积组间细菌的耐药率。结果共分离456株烧伤患者创面感染细菌,其中烧伤面积<10%TBSA组120株,10%~49%TBSA组135株,≥50%TBSA组201株。其中革兰阴性菌占52.2%(238株),以铜绿假单胞菌(104株,占22.8%)、鲍曼不动杆菌(39株,占8.5%)及肺炎克雷伯菌(27株,5.9%)为主;革兰阳性菌占47.8%(218株),以表皮葡萄球菌(50株,占11.0%)和金黄色葡萄球菌(44株,占9.6%)为主。不同烧伤面积创面感染的病原菌分布及耐药率不同。烧伤面积<10%TBSA时,病原菌以金黄色葡萄球菌为主;10%~49%TBSA组及≥50%TBSA组则以铜绿假单胞菌和鲍曼不动杆菌为主。≥50%TBSA组的细菌耐药率升高,其中铜绿假单胞菌对头孢类及碳青霉烯类抗生素耐药率分别为87.9%(58/66)、93.9%(62/66);检出的25株鲍曼不动杆菌均为多重耐药菌;耐甲氧西林金黄色葡萄球菌(MRSA)检出率为100%(9/9),高于<10%TBSA组和10%~49%TBSA组烧伤患者,差异有统计学意义(χ^(2)=6.836,P<0.05)。结论不同烧伤面积患者创面感染的病原菌分布不同,烧伤面积<10%时以革兰阳性菌为主,烧伤面积达10%以上时以革兰阴性菌为主,烧伤面积≥50%时细菌耐药性及多重耐药菌比例明显增加。

创伤后伤口感染病原菌监测及耐药性分析

目的探讨创伤患者伤口感染病原菌的分布及主要病原菌对常用抗生素的耐药情况，为临床伤口感染的防治及合理选择抗生素提供依据。方法对2004～2006年3年中自我院创伤患者伤口分泌物中分离的病原菌及耐药情况进行回顾性分析。结果自住院患者伤口分泌物分离的病原菌共计836株。伤口感染菌中革兰阳性菌占56．2％，革兰阴性菌占43．8％。伤口感染的主要病原菌中革兰阳性菌以金黄色葡萄球菌、表皮葡萄球菌和粪肠球菌为主，革兰阴性菌以鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌为主，阴沟肠杆菌和奇异变形杆菌也占有一定的比例。药敏结果显示，所调查细菌对常用抗生素耐药较为严重，并呈多重耐药。对革兰阳性球菌的治疗，万古霉素的敏感性最好。对于革兰阴性杆菌，头孢吡肟、头孢哌酮/舒巴坦、左氧氟沙星、亚胺培南的耐药率相对较低。结论了解创伤患者伤口感染的主要病原菌及耐药特点，有助于临床医生制定合理有效的用药方案，对控制患者伤口感染的发生和发展有着重要的意义。