骨科患者感染的病原菌分布及耐药性分析

目的 了解骨科常见的病原菌的分布及耐药性,为临床合理使用抗菌药物提供参考依据.方法 回顾性分析2008年3月-2010年12月430例骨科感染患者的资料,对其标本中分离出的病原菌级对抗菌药物的敏感试验结果进行统计,采用法国生物梅里埃公司ATB Expression系统进行鉴定.结果 430份送检标本中分离出212株病原菌,其中革兰阳性球菌占37.73％,革兰阴性杆菌占56.13％,真菌占6.13％；居前4位的病原菌分别是铜绿假单胞菌、金黄色葡萄球菌、表皮葡萄球菌、鲍氏不动杆菌,分别占20.28％、18.87％、13.2％、9.91％;耐甲氧西林金黄色葡萄球菌(MRSA)检出21株,检出率52.5％；葡萄球菌属是骨科患者感染的主要病原菌,对多种抗菌药物耐药,铜绿假单胞菌对各类抗菌药物包括碳青酶烯类均有较高的耐药率.结论 由于抗菌药物的广泛使用,细菌谱发生了改变,且对大部分常用抗菌药物产生了耐药性；临床使用抗菌药物前应常规进行培养,根据药物敏感试验结果,选择和调整用药,提高治疗效果.

Distribution and drug resistance of pathogens causing infections in patients of department of orthopedics

OBJECTIVE To explore common infection pathogen distribution and drug resistance in the department of orthopedics,to offer reference of the rational use of clinical antibiotics.METHODS The data of 430 patients in department of orthopedics from Mar 2008 to Dec 2010 were retrospectively analyzed,the drug susceptibility testing of the pathogens isolated from various specimens was performed,and the result was analyzed for statistics,the identification was performed by using ATB expression microbial system of BioMérieux,France.RESULTS A total of 212 strains pathogenic bacteria were isolated from 430 specimens,including gram-positive cocci(37.73%),gram-negative bacilli(56.13%),and fungi(6.13%);the top 4 species were Pseudomonas aeruginosa,Staphylococcus aureus,S.epidermidis and Acinetobacter baumannii,accounting for 20.28%,18.87%,13.2%,and 9.91%,respectively;totally 21 strains of methicillin-resistant S.aureus(MRSA) were detected with the detection rate of 52.5%;Staphylococcus were the major pathogens causing infections in patients of department of orthopedics and were multidrug-resistant,P.aeruginosa had relative high drug resistance to various commonly used antibiotics including carbapenem.CONCLUSION The bacterial spectrum has changed due to extensive use of antibiotics,with the drug resistance to common antibiotics;it is necessary to perform routine culture before the use of antibiotics,and to select and adjust the application so as to reduce the therapeutic effect.