伤口感染病原菌构成及耐药性分析

目的 了解我国创伤及术后伤口感染患者细菌分布及耐药状况.方法 采用纸片法、MIC法或E-TEST法,使用WHONET5.4软件进行分析,对卫生部全国细菌耐药性监测网所属86家三级甲等医院2006年6月1日至2007年5月31日分离的创伤及术后感染分泌物菌株进行分析.结果 (1)共分离细菌2125株,包括革兰阳性(G~+)菌994株(46.8%)和革兰阴性(G~-)菌1131株(53.2%),前三位细菌分别为葡萄球菌(780株、36.7%)、大肠埃希菌(338株、15.9%)和铜绿假单胞菌(231株、10.9%);(2)头孢西丁耐药的金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别为38.2%和84.1%,未发现对糖肽类耐药的葡萄球菌.(3)大肠埃希菌对三代、四代头孢萧素的耐药率约为60%～65%,对氟喹诺酮的耐药率为70%.(4)成人患者分离的葡萄球菌、大肠埃希菌对氨基糖苷类和喹诺酮类药物的耐药率明显高于儿童;(5)门急诊来源的葡萄球菌对头孢菌素、喹诺酮类、氨基糖苷类的耐药率明显低于住院患者来源细菌. 结论创伤及术后伤口感染的主要致病菌为葡萄球菌、大肠埃希菌和铜绿假单胞菌,MRSA检出率较同期整体监测细菌低,大肠埃希菌对头孢菌素耐药率较整体监测细菌高;成人分离菌耐药率高于儿童,门诊高于住院患者.

Bacterial composition and resistance of wound infections

Objective To determine the bacterial composition and resistance of wound infections in China. Methods Disc diffusion test,MIC test and E-test were used to detect the antimicrohial resistance of bacterial isolates from wound secretions.WHONET 5.4 was applied for analysis of the bacterial sensitive data from 86 domestic tertiary hospitals from June 1,2006 to May 31,2007. Results (1)2125 bacterial strains were coileeted in the survey period,which included 994 strains (46.8%) of Gram positive and 1131 strains (53.2%) of Gram negative bacteria,Staphylococcus(780 strains,36.7%),E.coli(338 strains,15.9%) and Pseudomonas aeruginosa (231 strains,10.9%)were the most common isolates.(2)38.2% and 84.1% of Staphylococcus aureus and Staphylococcus epidermidis were methicillin-resistant.respectively.No Staphylococcus strain was resistant to vancomycin or teicoplanin.(3)ESBLs positive rate of E.coli was about 60%,while the resistant rate to quinolones Was about 70%.(4)The resistant rates of Staphylococci and E.coli isolated from adults to aminoglyeoside and quinolones were higher than those from children.(5)The resistant rates of Staphylococei to cephalosporin,aminoglyeoside and quinolones from inpatients were higher than those from out-patients. Conclusion Staphylococci,E.coli and Pseudomonas aeriginoso were among the most common organisms isolated from wound infections.The ESBLs positive rate of E.coli from wound infections was higher than that from all specimen bacteria found in other surveys performed during the same period and the methicillin resistant Staphylococci were less than that.