外科伤口感染病原菌分布及耐药谱分析

目的 分析外科伤口感染的常见病原菌及其耐药性,为合理选择临床抗菌药物提供依据。方法 将 2012年1月—2017年12月山东省鱼台县人民医院外科伤口感染送检的感染患者标本,按照《全国临床检验操作规程》标准分离、培养、鉴定细菌并判别药敏结果,对感染的主要病原菌及耐药性进行回顾性分析。结果 448 份临床标本共分离出细菌 548株其中G- 菌360株,占65.69%(360/548),G+ 菌144株,占27.01% (148/548);真菌40株,占7.30%(40/548)。外科伤口感染以革兰阴性菌为主,在所有分离的病原体中,居于感染首位的是金黄色葡萄球菌(占17.88%),其次是阴沟肠杆菌(占13.87%)、大肠埃希菌(占9.31%)、铜绿假单胞菌(占8.94%)、肺炎链球菌(占7.85%)和肺炎克雷伯菌(占6.93%)。分离到6株白色假丝酵母菌,在ESBLs 革兰阴性菌当中,ESBLs+大肠埃希菌、ESBLs+铜绿假单胞菌、ESBLs+肺炎克雷伯菌检出率分别为 50.98% (26/51) 、44.90%(22/49)和31.58% (12 /38) 。革兰阳性菌以金黄色葡萄球菌对青霉素G耐药率高(85.71%),万古霉素对革兰阳性球菌均不耐药。肺炎链球菌对苯唑西林和克林霉素耐药率较高,分别为 83.72%和 81.40%,革兰阴性球菌对万古霉素亦均不耐药。革兰阴性杆菌大多对亚胺培南敏感,革兰阳性球菌未发现耐万古霉素。结论 尽早对外科伤口感染患者进行病原菌分离鉴定,并根据药敏试验结果合理选用抗菌药物,以防耐药菌株的产生。

Analysis of pathogen distribution and drug resistance spectrum of surgical wound infection

Objective To analyze the surgical wound infection common pathogens and their resistance so as to provide a reference for the rational choice of clinical antibacterial drugs. Methods The specimens of infected patients who were examined for surgical wound infection were isolated, cultured, identified, and discriminated according to the National Clinical Laboratory Operation Procedures criterion the People’s Hospital of Yutai County, Shandong Province from January 2012 to December 2017. The main pathogens and drug resistance were analyzed retrospectively. Results A total of 548 bacterial strains were isolated from 448 clinical specimens, including 360 strains of G-bacteria, accounting for 65.69% (360/548), 144 strains of G+ bacteria, accounting for 27.01% (148/548), and 40 strains of fungi, accounting for 7.30% (40/ 548). Among all the isolated pathogens, Staphylococcus aureus (17.88%) was the most, followed by Enterobacter cloacae (13.87%), Escherichia coli (9.31%), Pseudomonas aeruginosa (8.94%), Streptococcus pneumoniae (7.85%) and Klebsiella pneumoniae (6.93%). Six strains of Candida albicans were isolated. Among ESBLs Gram-negative bacteria, the detection rates of ESBLs+E. coli, ESBLs+Pseudomonas aeruginosa, and ESBLs+Klebsiella pneumoniae were 50.98% (26/51), 44.90% (22/49), and 31.58% (12/38) respectively. Among Gram-positive bacteria, the resistant rate of Staphylococcus aureus to penicillin G was 85.71%, but Gram-positive cocci were not resistant to vancomycin. The resistance rates of Streptococcus pneumoniae to oxacillin and clindamycin were higher, being 83.72% and 81.40%, respectively. Gram-negative cocci were also not resistant to vancomycin. The surgical wound infections were dominated by gram-negative bacteria, Gram-negative bacilli were mostly sensitive to imipenem, and Gram-positive cocci were not found to be resistant to vancomycin. Conclusion We should isolate and identify the pathogenic bacteria of surgical wound infection patients as soon as possible, and rationally select the antimicrobial drugs based on the drug sensitivity test results, so as to prevent the emergence of resistant strains.