化工企业成批烧伤患者感染病原菌的特点及耐药性分析

目的 回顾性分析本单位近年来成批烧伤患者和非成批烧伤患者院内感染的主要病原菌分布特点及其耐药性的流行病学变化。方法 将本科2008年1月-2014年12月收治的316例成批烧伤患者与同时期收治的361例非成批烧伤患者的病历资料进行对比，分析两组患者各年度创面分泌物、血液、痰液、气管套管及深静脉置管标本中的主要病原菌菌种、分布特点及其耐药性变化。结果 成批烧伤组感染革兰氏阳性(G＋)球菌与革兰氏阴性（Gˉ）杆菌的患者共176例（55.70%），非成批烧伤组感染革兰氏阳性球菌与革兰氏阴性杆菌的患者共135例（37.40%），成批烧伤组的感染发生率明显高于非成批烧伤组。成批烧伤组检出主要病原菌253株（52.93%），其中革兰氏阳性球菌139株（54.94%），分别为金黄色葡萄球菌91株，表皮葡萄球菌48株；革兰氏阴性杆菌105株（41.50%），分别为大肠埃希菌63株，铜绿假单胞菌42株；真菌9株（3.56%）。非成批烧伤组检出主要病原菌225株（47.07%），其中革兰氏阳性球菌127株（56.44%），分别为金黄色葡萄球菌101株，表皮葡萄球菌26株；革兰氏阴性杆菌90株（40.00%），与成批烧伤组略有不同，分别为铜绿假单胞菌51株，大肠埃希菌39株；真菌8株（3.56%）。成批烧伤组检出耐甲氧西林金黄色葡萄球菌（methicillin-resistant staphylococcus aureus，MRSA)59株（64.84%），耐甲氧西林表皮葡萄球菌（methicillin-resistant staphylococcus epidermis，MRSE）31株（64.58%）；非成批烧伤组检出耐甲氧西林金黄色葡萄球菌 61株（60.40%），耐甲氧西林表皮葡萄球菌16株（61.54%）。金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌和铜绿假单胞菌等常见致病菌对常用抗生素的耐药性均增加，并呈多重耐药性。结论 成批烧伤患者的感染发生率较非成批烧伤患者明显增加，且金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌和铜绿假单胞菌等常见致病菌对常用抗生素的耐药性均增加，并呈多重耐药性。

Characteristics and Drug Resistance of Pathogenic Bacteria Infections in Mass Burns Patients of Chemical Industries

Objective To retrospectively study the epidemiology of the distribution characteristics and drug resistance of hospital pathogenic bacteria infections in mass burns patients and individual burns patients admitted into our department in recent years. Methods The medical records of 316 mass burns patients and 361 individual burns patients admitted into our department between January 2008 and December 2014 were compared to analyze the main pathogenic bacterial strains, their distribution characteristics and drug resistance changes in collected specimens of wound secretion, blood, sputum, tracheal tube and deep venous catheter in each year. Results Infections of Gram-positive cocci and Gram-negative bacilli were detected in 176 patients (55.70%) of the group of mass burns, of which the incidence was significantly higher than that of the group of individual burns, wherein infections of Gram-positive cocci and Gram-negative bacilli were detected in 135 patients (37.40%). 253 strains(52.93%) of main pathogenic bacteria were detected in mass burns group, including 139 strains(54.94%) of Gram-positive cocci (91 strains of staphylococcus aureus and 48 strains of staphylococcus epidermidis), 105 strains(41.50%) of Gram-negative bacilli (63 strains of E coli and 42 strains of pseudomonas aeruginosa) and 9 strains of fungi (3.56%), while totally 225 strains of pathogenic bacteria were detected in individual burns group (40.00%), of which 127 strains (56.44%) were Gram-positive cocci (101strains of staphylococcus aureus and 26 strains of staphylococcus epidermidis), 90 strains(43.56%) were Gram-negative bacilli (51 strains of pseudomonas aeruginosa and 39 strains of E coli) and 8 strains of fungi (3.56%). 59 strains (64.84%) and 61 strains (60.40%) of MRSA (methicillin-resistant staphylococcus aureus), as well as 31 strains(64.58%) and 16 strains(61.54%) of MRSE(methicillin-resistant staphylococcus epidermis) were detected in mass burns and individual burns groups respectively. The drug resistance of the common pathogenic bacteria such as staphylococcus aureus, staphylococcus epidermidis, E coli and pseudomonas aeruginosa to common antibiotics was increased year by year, presenting multiple-drug resistance. Conclusion The incidence of infection in mass burns patients is significantly higher than that in individual burns patients. In addition, common pathogenic bacteria such as Staphylococcus aureus, staphylococcus epidermidis, E coli and pseudomonas aeruginosa all show increased drug resistance to common antibiotics and multiple-drug resistance.