慢性难愈合创面细菌耐药性分析

目的比较慢性难愈合创面细菌菌种及药物敏感性差异,以指导临床合理使用抗生素.方法选取1989～2003年间中山大学附属第一医院488例慢性难愈合创面住院患者中行创面分泌物细菌培养者100例作为研究对象,对创面细菌培养及药敏结果进行回顾性分析.结果（1）慢性难愈合创面最常见细菌为铜绿假单胞菌（30.1%）、金黄色葡萄球菌（15.0%）、大肠埃希菌（10.6%）.（2）革兰阴性杆菌对亚胺培南的敏感率为92.7%,对头孢哌酮/舒巴坦为84.2%,阿米卡星为76.9%,环丙沙星为61.2%;革兰阳性杆菌对万古霉素、氯霉素和复方新诺明敏感率依次为94.7%、52.9%和80.0%.（3）慢性难愈合创面铜绿假单胞菌对亚胺培南、头孢他啶和替卡西林/克拉维酸的敏感率依次为95.7%、72.7%和70.0%;金黄色葡萄球菌对药物的敏感率分别为氯霉素100%、万古霉素90.9%、甲氧苄啶/磺胺甲噁唑90.0%.结论（1）慢性难愈合创面革兰阳性菌对万古霉素高度敏感,革兰阴性菌对亚胺培南高度敏感.（2）耐万古霉素菌株出现,合理用药意义重大.

Comparing bacteria cultivation and the sensitivity to antibiotics in chronic wounds

Objective Comparing the difference in strains and the sensitivity to antibiotics in chronic wounds,so as to provide assistance to the reasonable use of anbitiotics clinically.Method A retrospective analysis of bacterial cultures from wounds and drug sensitivity results in chronic wounds of 100 patients during 1989 to 2003 in our hospital.Results The most common pathogens were Pseudomonas aeruginosa(30.1),Staphylococcus aureous(15.0%),and Escherichia coli(10.6%) in chronic wounds.The susceptibility rate of Imipenem against all of the gram negative bacilli in chronic wounds were 92.7%,Cefoperazone/Sulbactam(84.2%),Amikacin(76.9%),and Cirprofloxacin(61.2%),The susceptibility rate of Vancomycin,Chiloramphenicol,and Trimethoprim+Sulfamethoxazole against all of gram positive cocci in both wounds were 94.7%,52.9% and 80.0%,respectively.The susceptibility rate of Pseudomonas aeruginosa were 95.7%,ceftazidime(72.7%),Ticarcillin/Clavulanic Acid(70.0%).The susceptibility rates of Staphylococcus aureus to chloramphenicol,Vancomycin and Trimethoprim+Sulfamethoxazole were 100%,90.9%,respectively and 90.0%.Conclusions The most effective antibiotics against the pathogens in chronic wounds were Imipenem and Vancomycin.With the advent of Vancomycin-resistant Staphylococcus aureus(VRSA),the rational use of antibiotics becomes more important.