汶川地震致四肢开放性损伤伤员细菌感染分布及药敏监测

目的 对汶川大地震中414例四肢开放性损伤伤员细菌感染分布特性及药敏结果进行分析,以指导临床特别是自然灾害中抗生素的使用.方法 对414例四肢开放性损伤伤员的创面分泌物进行细菌培养和药敏监测.结果 G+球菌12例(2.9%),G-杆菌66例(15.9%),G+杆菌2例(0.5%),多重感染6例(二重感染5例,三重感染1例),感染率为1.5%.主要致病菌:(1)G+球菌:表皮葡萄球菌、金黄色葡萄球菌、人葡萄球菌;(2)G-杆菌:阴沟肠杆菌、鲍曼不动杆菌、大肠埃希菌、铜绿假单胞细菌、普通变性菌、美洲爱文菌;(3)G+杆菌:枯革芽孢杆菌.对G+球菌较敏感的药物有万古霉素、利福平、左旋氧氟沙星、庆大霉素;对G+球菌敏感较低的药物有青霉素、氨苄西林、红霉素等.对G-杆菌较敏感的药物有亚胺培南、丁胺卡那霉素、左旋氧氟沙星、妥布霉素;对G-杆菌敏感较低的药物有氨苄西林、哌拉西林等.结论 地震中四肢开放性损伤伤员细菌感染率较高,感染菌株种类较多.因此,应尽早作创面分泌物的细菌培养+药敏鉴定,针对性合理使用抗生素.

Bacterial infection distribution and drug sensitivity monitoring In patients with open extremity in-juries caused by Wenchuan earthquake

Objective To analyze results of bacterial infection distribution and drug sensitivity monitoring in 414 patients with open extremity injuries caused by Wenchuan earthquake so as to provide advices for guiding utility of antibiotics in treatment of patients injured in natural disasters. Methods Bacterial culture of wound secretion substance and drug sensitivity monitoring were done in 414 patients with open extremity injuries. Results There were 12 patients (2.9%) with G+ coccobacteria, 66 (15.9%) with G- bacillus, 2 (0.5%)with G+ bacillus, 6 (1.5%) with multiplicitas infection(5 with dual infection and I with triplication infection). Main pathogenic bacteria were as follows: (1)G+cocco- bacteria including Staphylococcus epidermidis, Staphylococcus aureus and anthropo-staphylococci ; (2) G- bacillus including Aerobacter cloacae, banmanii, escherichia co]i, aerugo pseudomonas, proteusvul- gaffs and Ewingella americana. (3)G+ bacillus including bacillus subtilis. The drugs with high sensi0tivi- ty to G+ coccobacteria included vancomycin, rifampin, levofloxacin and cidomycin, but those with low sensitivity to G+coccobacteria included penicillin, ampicillin and erythremycin. The drugs with high sen- sitivity to G- bacillus included imipenem, amikacin, levofloxaciu and tenebrimycin, but those with low sensitivity to G-bacillus included ampicillin and piperacillin. Conclusions Patients with open ex- tremity injuries caused by earthquake have rather high bacterial infection rate, involving many kinds of in- fection strains. Therefore, we should do bacterial culture and drug sensitivity monitoring of wound excre- tion substance as early as possible to guide rational use of antibiotics.