伤口分泌物的病原菌分布及耐药性分析

目的调查福建省龙岩市第二医院伤口分泌物病原菌的分布及耐药情况，为合理应用抗生素提供依据。方法收集2012年1月至2013年5月患者伤口分泌物标本,采用常规方法进行分离培养，用VITEK-2 Compact全自动微生物分析仪系统进行鉴定及药敏分析。结果送检503份标本，培养阳性272份，阳性率为54. 1% ;病原菌检出343株，其中革兰阴性菌189株占55. 1%，革兰阳性菌151株占44.0%，真菌3株占0.9% ;前5位的病原菌分别为金黄色葡萄球菌、凝固酶阴性葡萄球菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别是30.4%、82. 1%。粪肠球菌中耐高浓度氨基糖苷类肠球菌（HLAR）的检出率为55%。革兰阳性菌对万古霉素、替加环素、利奈唑胺未出现耐药菌株。铜绿假单胞菌、肠杆菌科细菌对亚胺培南的耐药率分别为5. 6%、0。大肠埃希菌中超广谱P-内酰胺酶（ESBL）的检出率是42.9%。鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率最低为25.0%,对其他抗菌药物耐药严重，多数抗菌药物的耐药率均〉45%。结论伤口感染的主要病原菌是革兰阴性菌，多重耐药菌株比例较高，临床应根据药敏结果合理选用抗生素,减少新的耐药菌株出现。

Distribution and drug resistance of pathogens in wound secretion

Objective To investigate the distribution and drug resistance of pathogens in wound secretions in our hospital, so as toprovide basis for rational clinical use of antibiotics. Methods Strains isolated from wound infection patients in our hospital from January2012 to May 2013 were identified and done drug susceptibility test by VITEK-2 Compact bacteria analysis system. Results A total of 503wound secretion samples were collected, and 272 samples cultivate positive. The 343 bacterial strains were isolated. Gram-negative bacteria and Gram-positive bacteria accounted for 55. 1% （189 strains） and 44. 0% （151 strains） , respectively, fungus 0. 9% （3 strains）;the most common pathogens were S. aureus, coagulase-negative Staphylococci, P. aerugionsa, E. coli and A. baumannii. The detection rateof methicillin resistant strains in S. aureus （ MRSA） and coagulase-negative Staphylococci （ MRCNS） were 30. 4% and 82. 1%,respec-tively. The detection rate of high level aminoglycoside resistance （ HLAR） in the E. faecalis strains was 55%. No Gram-positive bacteriastrain was found resistant to vancomycin, tegecycline or linezolid. The drug resistance rate of the P. aerugionsa and enterobacteriaceae toimipenem were 5. 6% and 0,respectively. The detection rate of the ESBL-producing E. coli was 42. 9% . The drug resistance rate of A.baumannii to cefoperazone/sulbactam was the lowest （25. 0% ）,A. baumannii was highly resistant to other antibiotics, the drug resistanceto most of the antibiotics was over 45% . Conclusion The major pathogens of wound infection was gram-negative bacteria, the multidrug-resistant bacteria occupy a large proportion. It is suggested that antibiotics should be used reasonably under the guidance of antibiotic susceptibility test so as to prevent the emergence of the drug resistant strains.