汶川地震致头皮伤口感染细菌谱及耐药性分析

目的探讨地震灾害引起的开放性头皮损伤伤121感染的病原菌分布，耐药性特点及抗生素治疗措施。方法回顾分析5·12汶川地震后，四川大学华西医院神经外科收治的38例开放性颅伤患者头皮伤口感染的病原学资料。结果全组38例开放性头皮伤口感染的病原菌菌株51株，革兰阳性菌35株（68．63％），分别是金黄色葡萄球菌21株（41．18％），表皮葡萄球菌14株（27．45％）；革兰阴性菌16株（31．37％），分别是阴沟肠杆菌8株（15．69％），肺炎克雷伯杆菌4株（7．84％），绿脓杆菌2株（3．92％），深红沙雷氏菌2株（3．92％）。这些菌株对临床常用抗生素都有不同程度的耐药。经彻底清创及应用敏感抗生素，能有效控制感染。结论地震引起的开放性头皮伤口感染的病原菌，多以革兰阳性的金黄色葡萄球菌感染为主。早期彻底清创，营养支持，应用敏感抗生素能提高治疗效果。

Spectrum of pathogenic bacteria from infected scalp laceration after Wenchuan earthquake and drug resistance thereof

Objective To investigate the spectrum of pathogenic bacteria from infected scalp laceration after Wenchuan earthquake and the resistance to antibiotics of these bacteria. Methods Specimens of secretion from 30 earthquake victims with infected scalp laceration, 22 tames and 16 females, aged 41.4 （2 ~ 77）, underwent bacterial culture. The resistance and sensitivity to antibiotics were tested. Results Fifty strains of pathogenic bacteria were isolated. 35 strains （68.63%） were Gram-positive cocci, such as Staphylococcus aureus （41.18%） and S. epidermidis （27.45%）; and 16 strains （31.37%） were Gram-negative bacteria, mainly Enterobacter cloacae （15.69%）, Klebsiella pneumoniae （7.84%）, Pseudomonas aeruginosa （3.92%）, and Serratia rubidea （3.92%）. All Gran-positive bacteria were resistant to penicillin and ampicillin, and sensitive to vaneomycin. The Gram-negative bacteria were all sensitive to imipenem and were with higher resistant rates to many antibiotics than Gram-positive bacteria. Thorough debridement and application of sensitive antibiotics effectively control the infection. Conclusion Gram-positive Staphylococcus aureus and S. epidermidis are the most common pathogens of scalp laceration in earthquake victims. Early and thoroughly debridement, nutritional support, and application of sensitive antibiotics improve the clinical outcome.