2013—2016年海口市第一八七医院四肢创伤性骨折感染病原菌的分布及其耐药性分析

目的 探讨2013—2016年海口市第一八七医院四肢创伤性骨折感染病原菌的分布和耐药性情况,为临床合理用药提供依据.方法 对海口市第一八七医院2013年3月—2016年3月收治的四肢创伤性骨折住院患者3841例进行回顾性分析,收集病原菌感染的83例患者的资料,对其病原菌的分布及药敏结果进行回顾性分析.结果 共分离出病原菌89株,其中革兰阴性菌28株,构成比为31.46%,主要为大肠埃希菌、阴沟肠杆菌、肺炎克雷伯菌、铜绿假单胞菌和产气肠杆菌;革兰阳性菌61株,构成比为68.54%,主要为金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌和鸟肠球菌.大肠埃希菌对氨苄西林、左氧氟沙星、舒巴坦、超广谱β内酰胺酶、头孢曲松、头孢唑啉的耐药率为70.00%~100.00%;而对厄他培南、哌拉西林、丁胺卡那霉素、红霉素、亚胺硫霉素敏感.阴沟肠杆菌对亚胺硫霉素的耐药率为0.00%,对其他抗菌药物的耐药率为25.00%~100.00%.革兰阳性菌中金黄色葡萄球菌和表皮葡萄球菌均对氨苄西林、达福普丁、利奈唑胺、替加环素、呋喃妥因敏感,表皮葡萄球菌还对环丙沙星敏感,耐药率为0.00%;两者对青霉素均不具有耐药性,耐药率为100.00%.此外,两者对其他的抗菌药物耐性率均不达50.00%.结论 海口市第一八七医院四肢创伤性骨折感染病原菌以革兰阳性菌为主,临床应结合药敏试验,合理选用抗菌药物;同时要重视加强细菌耐药性的检测.

Analysis on distribution and drug resistance of pathogenic bacteria of patients with traumatic limbs fracture in No.178 Hospital of Haikou from 2013 to 2016

Objective To investigate the distribution and drug resistance of pathogenic bacteria of patients with traumatic limbs fracture in No.178 Hospital of Haikou from 2013 to 2016, and to provide reference for clinical rational drug use. Methods Inpatients (3841 cases) with traumatic limbs fracture in No.178 Hospital of Haikou from March 2013 to March 2016 were analyzed retrospectively. The data of 83 cases of patients infected by pathogenic bacteria was selected, and the distribution and drug resistance of pathogenic bacteria were analyzed retrospectively. Results Totally 89 strains of pathogens were isolated, in which Gram-negative bacteria were 28 strains (31.46%), main of them were Escherichia coli,Enterobacter cloacae,Klebsiella pneumoniae,Pseudomonas aeruginosa, and Enterobacter aerogenes. Gram-positive bacteria (61 strains) accounted for 68.54%, and main of them were Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecalis, and Enterococcus avium. The resistance rates of E. coliagainst ampicillin, levofloxacin, sulbactam, extended spectrumβ lactamases, ceftriaxone, and cefazolin were 70.00% — 100.00%.E. coli was sensitive to ertapenem, piperacillin, amikacin, erythromycin, and imipenem. The resistance rate of E. cloacaeagainst imipenem was 0.00%, and against other antibiotics were 25.00% — 100.00%. In Gram-positive bacteria,S. aureus and S. epidermidis were sensitive to ampicillin, dalfopristin, linezolid, tigecycline, and macrodantin.S. epidermidiswas also sensitive to ciprofloxacin, and the resistance rate was 0.00%. The sensitive rates of S. aureus and S. epidermidisagainst penicillin were 100.00%. Besides, the sensitive rates of S. aureus and S. epidermidisagainst other antibiotics were less than 50.00%.Conclusion The main pathogens of patients with traumatic limbs fracture in No.178 Hospital of Haikou is Gram-positive bacteria. It is important to choose rational antibiotics according to the drug sensitive test and enhance the detection of drug resistance.