骨科感染病原菌谱与抗菌谱3年报告

目的]了解骨科病人所感染菌群及其耐药性,指导临床正确应用抗生素。方法]对骨科门诊及病房细菌感染病人的708份分泌物、脓液等标本进行需氧培养,并对检出菌按K-B法做体外药敏实验。结果]检出致病菌259株,G 菌占47.9%,其中金黄色葡萄球菌33.0%,凝固酶阴性葡萄球菌14.9%;G-菌占52.1%,其中假单胞菌属占7.3%,不动杆菌属占6.1%。药敏显示革兰阳性球菌对青霉素及苯唑青霉素的耐药率逐年升高,对万古霉素的敏感性最高为100%。革兰阴性杆菌对亚胺培南的敏感率最高,3年平均95.8%,对头孢他啶也较敏感,但有逐年下降的趋势,对环丙沙星、阿米卡星、哌拉西林的耐药率较高,分别为46.0%、47.0%、51.2%。结论]骨科病人感染的病原菌中,G-杆菌占大多数且有上升趋势,G 球菌感染发生率少于G-杆菌,单菌株以金黄色葡萄球菌占首位。对G-球菌可以选用万古霉素、苯唑青霉素、诺氟沙星等;对G-杆菌可以选用亚胺培南、头孢他啶。革兰阴性杆菌引起骨科感染有上升趋势,耐药也较严重,加强感染菌及药敏检测,合理使用抗生素非常必要。

Pathogenic bacteria and drug-resistance in orthopedics patients: a review of the past three years

Objective To investigate the pathogenic bacteria and drug resistance in orthopedics patients, so as to guide the clinical use of antibiotics.Method708 secretions and pus samples from orthopedic outpatients and inpatients were cultured aerobically.The detectable bacteria were subjected to drug sensitivity test in vitro by the K-B assay.Result259 pathogenic strains were detected, and 47.9% of them were Gram-positive (Staphylococcus aureus, 33.0%: coagulase-negative staphylococci, 14.9%),and the remaining 52.1% were Gram-negative (Pseudomonas, 7.3%; Acinetobacter, 6.1%). The drug-resistant rate of Gram-positive cocci to penicillin and oxcillin tended to raise over the three years : however, all the detected Gram-positive cocci were sensitive to vancomycin (100%).Most Gram-negative bacilli were sensitive to imipenem (95.8%) in the past three years and the sensitivity to ceftazidime was also high; however, the sensitivity tended to fall over the past three years. The drug-resistant rates of Gram-negative bacilli to CiprofIoxacin. amikacin and piperacillin were 46.0%. 47.0% and 51.2% respectively.ConclusionGram-negative bacilli dominate the pathogenic bacteria in orthopaedic patients and they tend to increase. The incidence of infections by Gram-positive cocci is lower than that of infections by Gram-negative bacilli. In terms of individual bacteria ,staphylococcus aureus leads among all of these pathogenic bacteria, Vancomycin, Oxacillin and Norfloxacin are preferred drugs against Gram-positive cocci, while imipenem and ceftazidime are preferred for Gram-negative bacilli.The incidence of infections by Gram-negative bacilli tend to raise and drug resistance of Gram-negative bacilli becomes serious:hence, it is crucialOto emphasize the detection of infectious bacteria and drug sensitive test and to use antibiotics rationally.