776 株伤口感染病原菌分布及耐药分析

目的 了解我院临床伤口感染患者细菌分布情况及其主要病原菌对各类抗生素的耐药状况,为临床伤口感染的防治及合理选择抗生素提供依据.方法 用WHONET5.6软件对2010-09～2013-09间在我院住院伤口感染分泌物中分离的病原菌及耐药情况进行回顾性统计分析.结果 共分离菌株776株,其中革兰阳性菌占34.9％ （271/776）,以金黄色葡萄球菌15.5％（120/776）、肠球菌属13.1％ （102/776）为主;革兰阴性菌占55.7％（432/776）,以大肠埃希菌15.7％（122/776）、铜绿假单胞菌11.3％（88/776）、克雷伯菌属9.0％（70/776）、鲍曼不动杆菌4.4％（34/776）为主;酵母菌属9.4％ （73/776）.耐甲氧西林金黄色葡萄球菌（MRSA）检出率为45.0％ （54/120）,未发现对万古霉素耐药的金黄色葡萄球菌.屎肠球菌对抗菌药物的整体耐药性明显高于粪肠球菌.大肠埃希菌和肺炎克雷伯菌超广谱B内酰胺酶（ESBLs）检出率分别为52.5％ （64/122）和27.1％（19/70）;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耐药率高于50％;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6.8％和55.8％.结论 了解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.

Analysis of the Distribution and Drug Resistance of 776 Wound Infection Strains of Bacteria

Objective To investigate the distribution and antibiotic resistance of the bacteria isolated from the infectious wound in pa- tients of the hospital, and to guide the prevention and treatment and rational choice and clinical use of antibiotic for the wound infection in the future. Methods WHONETS. 6 was applied for retrospective analysis for the data of pathogens and drug resistance of the bacteria isola- ted from the infectious wound in patients of the hospital from September, 2010 to September, 2013. Results A total of 776 strains were i- solated. Gram negative bacillia accounting for 55.7% （432/776）, was the main infection, followed by gram positive cocci, accounting for 34.9% （271/776）, and fungus accounted for 9.4% （73/776）. Among the Gram negative bacillis, Escherichia coli accounted for 15.7% （122/776）, Pseudomonas aeruginosa accounting for 11.3 % （88/776）, Klebsiella accounting for 9.0% （70/776）, Acinetobacter bau- mannii accounting for 4.4% （34/776）, were the main pathogens. Of these Gram - positive bacteria, Staphylococcus aureus and Enterococ- cus were the main pathogens, accounting for 15.5% （120/776） and 13.1% （ 102/776）, respectively. Detection rate of MRSA was 45.0% （54/120）, and no vancomycin -resistance staphylococcus aureus was found. The overall antibiotic resistance was higher in Enterococcus faecium than in Enterococcus faecalis. Detection rates of ESBLs were 52.5% （64/122） and 27.1% （19/70） in Escherichia coli and in klebsiella pneumoniae, respectively. And Escberichia coli was with higher antibiotic resistance than klebsiella pneumoniae. Over 50% of Acinetobacter baumannii was resistant to mostly used antibiotics. Some Pseudomonas aeruginosa and Acinetobacter baumannii was found to be imipenem resistance, accounting for 6.8% and 55.8%, respectively. Conclusion The study of distribution and antibiotic resistance of the bacteria isolated from the infectious wound in patients will promote the rational choice and use of antibiotic in clinic, and have a great significance for wound infection prevention and control.