骨科创伤感染患者伤口病原菌分布及耐药性分析

目的了解骨科创伤感染患者病原菌分布特点,为合理使用抗菌药物提供依据。方法分析本院2014～2016年骨科创伤患者伤口感染2302株病原菌分布特点及对抗菌药物敏感性,对细菌培养阳性并鉴定细菌采用K-B纸片扩散法及最低抑菌浓度琼脂稀释法进行药物敏感性试验。结果 4903份感染伤口共分离出53种2302株细菌,前十位细菌占68.02%。革兰阴性菌占41.52%,革兰阳性菌占26.49%。革兰氏阴性菌前几位为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯杆菌。革兰氏阳性菌前几位为金黄色葡萄球菌、粪肠球菌。药敏结果:铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为9.6%和9.1%;鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为49.6%和46.6%;肠杆菌科细菌对两种碳青霉烯类的耐药率在10%以下。未发现对万古霉素、替考拉宁和利奈唑胺耐药的凝固酶阴性葡萄球菌及金黄色葡萄球菌。结论骨科创伤感染患者伤口分泌物未检出耐利奈唑胺、万古霉素和替考拉宁的凝固酶阴性葡萄球菌及金黄色葡萄球菌株。革兰阴性杆菌呈多重耐药性,均有检出耐碳青霉烯类抗生素的菌株,应积极采取有效措施遏制此类细菌在医院的扩散传播。

Distribution and drug resistance of pathogenic bacteria in patients with orthopedic trauma infection

Objective To investigate the distribution of pathogenic bacteria in patients with orthopedic trauma infection,in order to provide the basis for rational use of antibacterial agents. Methods We analyzed the distribution and susceptibility to antibiotics of 2302 strains of pathogenic bacteria in patients with orthopedic trauma in our hospital from 2014 to 2016. Pathogens that positive in bacterial culture were identified and drug susceptibility test were conducted using K-B disk diffusion method and minimal inhibitory concentration agar dilution method. Results A total of 53 kinds,2302 strains of bacteria were isolated from 4903 infected wounds, with the top ten bacteria accounting for 68.02%. Gram-negative bacteria accounted for 41.52% and Gram-positive bacteria accounted for 26.49%. The first few Gramnegative bacteria were Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. The first few Gram-positive bacteria were Staphylococcus aureus and Enterococcus faecalis. Drug susceptibility results showed that the resistance rate of Pseudomonas aeruginosa to imipenem and meropenem were 9.6% and 9.1%, respectively; resistance rate of Acinetobacter baumannii to imipenem and meropenem were 49.6% and 46.6%, respectively; resistance rate of Enterobacteriaceae to the two carbapenems were less than 10%. No coagulase-negative staphylococci and staphylococcus aureus were found to be resistant to vancomycin, teicoplanin and linezolid. Conclusion Linezolid, vancomycin and teicoplanin-resistant coagulase-negative Staphylococcus aureus and Staphylococcus aureus strains were not detected in wound secretions of patients with orthopedic trauma infection. Gram-negative bacilli showed multi-drug resistance, all of which had strains detected to be resistant to carbapenem. Effective measures should be taken to prevent the spread of such bacteria in hospitals.