烧伤病房病原菌分布与抗药性分析及对策

目的研究烧伤病区病原菌分布及耐药情况,以探索对策。方法以2003年1月至2005年12月烧伤病区送检标本中的阳性菌作为研究对象,对其菌种分布特点及耐药性进行分析。结果革兰阴性菌比例高于革兰阳性菌,其中革兰阳性菌292株（42．8％）,金黄色葡萄球菌分离率占首位（16．7％）,金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）的分离率较高（82．5％）;革兰阴性菌372株（54．5％）,分离率较高的分别为铜绿假单孢菌（12．5％）、大肠埃希菌（11．1％）、鲍曼复合醋酸钙不动杆菌（9．1％）和阴沟肠杆菌（8．2％）;超广谱B．内酰胺酶（ESBLs）在大肠埃希菌和肺炎克雷伯菌中的检出率分别为60．8％和42．9％;真菌检出18例（2．6％）,后两年较第一年有所下降。病原菌中条件致病菌增多;各种病原菌对抗生素的耐药性逐年上升。结论烧伤病区细菌耐药问题严重,抗生素的应用状况与病原菌的分布和耐药性相关,需要严格抗生素的应用指征,并采用良好的消毒隔离措施,以有效控制细菌感染和耐药性的扩散。

Pathogenic bacteria distribution and drug resistance analysis in burns department

OBJECTIVE: To study the distribution and drug resistance of pathogenic bacterium and find the proper measures of infection control. METHODS: Six hundred and eighty-two pathogenic bacteria strains were isolated and cultured from samples collected from January 2003 to December 2005. The pathogenic bacterium distribution and antibiotic resistance were analyzed. RESULTS: The detection rate of gram-negative bacteria was higher than gram-positive ones. The gram-positive bacteria accounted for 292 strains (42.8%), in which the detection rate of staphylococcus aureus is highest (16.7% of total) and the detection rate of methicillin-resistant staphylococcus aureus accounted for 82.5% in staphylococcus aureus strains. Among 372 gram-negative bacteria strains (54.5%), the detection rate of bacillus aeruginosu, escherichia coli, baumanii and enterobacter cloacae were 12.5%, 11.1%, 9.1% and 8.2% respectively; extended-spectrum betalactamases (ESBLs) were detected in 45 (60.8%) escherichia coli and 9 (42.9%) klebsiella pneumoniae strains. Eighteen strains of fungus were found, and it decreased in last 2 years. The detection rate of opportunistic pathogenic bacteria and the antibiotic resistant strains kept increasing in the 3 years. CONCLUSIONS: Drug resistance of pathogenic bacterium is very serious in burns department. The irrational use of broad-spectrum antibiotics and the antibiotic detection of pathogenic bacterium are all contributed to the drug resistance. It is important to enhance the asepsis, prevent hospital infection, detect the pathogenic bacteria and use antibiotics rationally in burns department.