开放性骨折伤口感染创面细菌学观察及耐药性研究

目的探讨开放性骨折患者手术后伤口的细菌学特点及对抗生素的耐药性分析。方法为回顾性病例分析,本院2010年2月-2013年2月收治的开放性骨折手术后伤口感染患者152例,取伤口分泌物,做细菌学检查及药敏试验,分析不同细菌对抗生素的耐药情况。结果开放性伤口创面感染的细菌以G-杆菌为主,占51.45%,其中铜绿假单胞细菌占19.67%;G+球菌中以金黄色葡萄球菌为主,占19.32%,不同细菌对青霉素的耐药率较高,G+球菌对万古霉素敏感性最高,万古霉素为100%,即未发现耐药菌株;G-杆菌中大肠埃希菌菌数比例最高,13.5%,其对青霉素的耐药率为87.6%,对亚胺培南敏感性最高,为97.4%。结论开放性骨折患者手术伤口感染的细菌以G-杆菌多见,该组菌对万古霉素及亚胺培南均敏感。但不同种类的细菌其致病毒理有所变化,应结合临床经验,根据不同细菌学特点和药敏试验结果制定外伤后及术前、术中、术后的抗生素应用方案,并加强对患者伤口的护理,以控制或减少开放性骨折手术后伤口感染的发生。

Bacteriological observation of open fractures and study of the drug resistance of those bacteria

Objectives To analyze the bacteriological characteristics of wounds after surgery to treat an open fracture and to analyze antibiotic resistance in order to facilitate the rational use of antibiotics. Methods Data from 152 patients who underwent surgery to treat an open fracture from February 2012 to February 2013 were retrospectively analyzed.Wound secretions were collected and subjected to bacteriological testing and obtained bacteria were subjected to a susceptibility test in order to analyze the antibiotic resistance of different bacteria. Results Gram-negative bacteria were most prevalent,accounting for 51.45%of the bacteria infecting open wounds.Different bacteria were resistant to penicillin at different rates ranging from 65.3% to 89.6%.Vancomycin was the most active antibiotic with the lowest resistance（0%）,and no drug-resistant strains were identified.Gram-positive bacteria accounted for 41.3%of the bacteria infecting open wounds.Staphylococcus aureus was the most prevalent Gram-positive bacteria,accounting for 19.32%of the bacteria infecting open wounds.The pathogens isolated from cultured wound secretions from patients with an open fracture were Escherichia coli（13.5%）,Staphylococcus epidermidis（11.64%）,Acinetobacter baumannii（8.93%）,and Pseudomonas aeruginosa（9.34%）.Gram-positive bacteria were most sensitive to vancomycin.The most prevalent Gram-negative bacterium was E.coli,which accounted for 13.5%,and its resistance to penicillin was 87.6%.However,Gram-negative bacilli were most susceptible to imipenem（at a rate of 97.4%）. Conclusion Gram-negative bacilli were the most prevalent bacteria cultured from infected wounds after patients were treated for an open fracture,but Gram-negative bacilli were sensitive to vancomycin and imipenem.That said,different bacteria result in different pathogenic changes.A plan for use of antibiotics before,during,and after surgery should be formulated when treating trauma in conjunction with clinical experience and based on characteristics of di