伤口感染病原菌分布及耐药性分析

目的了解医院2011年9月至2012年8月伤口分泌物培养的病原菌分布及常见致病菌的耐药情况。方法伤口分泌物标本统一接种血培养基、巧克力培养基和沙保氏培养基,采用ATB鉴定药敏分析仪作鉴定和药敏试验。结果在593份标本中,共分离致病菌364株,阳性率为61.4%,其中革兰阴性菌237株(65.1%),革兰阳性菌114株(31.3%),真菌13株(3.6%)。感染率居前3位的细菌依次是铜绿假单胞菌(17.3%)、金黄色葡萄球菌(15.4%)、大肠埃希菌(13.5%)。肠杆菌科细菌对碳青霉烯类耐药率为0%,大肠埃希菌、克雷伯菌属超广谱β-内酰胺酶(ESBLs)检出率分别为73.5%和37.5%。耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌阳性率分别是35.7%和81.3%。未发现耐万古霉素的葡萄球菌和肠球菌。结论伤口化脓性感染的主要病原菌是革兰阴性杆菌,临床医生应及时进行细菌培养及药敏试验,为临床抗菌治疗提供依据,从而有效控制伤口院内感染发生率。

Pathogen distribution and resistance analysis of wound infections

Objective To investigate the distribution and resistance of wound infections in hospital during Sep.2011to Aug.2012.Methods The wound secretion samples were cultured by blood agar,chocolate agar and sabouraud agar,using ATB system for identification and drug sensitivity analysis.Results 364strains(61.4%)were isolated from 593wound secretion samples,including 237strains(65.1%)Gram-negative bacteria,114strains(31.3%)Gram-positive bacteria,and 13stains(3.6%)fungi.The top three pathogens were Pseudomonas aeruginosa(17.3%),Staphylococcus aureus(15.4%),and Escherichia coli(13.5%).The resistance rate of Enterobacteriaceae bacteria to imipenem and meropenem was 0%.ESBLs-producing strains accounted for 73.5%,and Escherichia coli for 37.5%in Klebsiella spp.Methicillin resistant strains of Staphylococcus aureus(MRSA)and coagulase negative Staphylococcus(MRCNS)accounted for 35.7% and 81.3%,respectively.No Staphylococcus and Enterococcus was resistant to vancomycin.Conclusion Gram-negative bacteria were the predominant pathogens in wound infections.Clinicians should timely perform the bacterial culture and drug sensitivity test to provide the basis for clinical antimicrobial therapy,which is meaningful for the hospital infection cure.