伤口感染病原菌分布及耐药谱分析

目的探讨创伤患者伤口感染的常见病原菌及其耐药性，指导临床合理用药。方法回顾分析2010年至2012年创伤患者感染伤口分泌物的细菌分离培养及体外药物敏感试验，对感染的主要病原菌及耐药性进行分析。结果分离到细菌1086株，居于感染首位的是金黄色葡萄球菌（23．6％），其次是大肠埃希菌（23．2％），肺炎克雷伯菌（10．2％），鲍曼不动杆菌（8．8％），铜绿假单胞菌（6．6％），分离到8株白色假丝酵母菌（0．7％）；耐甲氧西林金黄色葡萄球菌（metieillin—multiple resistance S．attrelts，MRSA）检出率为71．5％，MRSA除对万古霉素、利奈唑胺100％敏感外，对其他常用抗菌药物均存在较高的耐药性，与MRSA的耐药性明显高于MSSA（P〈0．01）。产超广谱B一内酰胺酶菌株（extended—spectrumbeta—lactamase，ESBLs）的检出率为64．5％，除碳青霉烯类抗菌药物外，ESBLs对喹诺酮类、氨基糖甙类等的常用抗菌药物存在较高的耐药率；其耐药率远高于非ESBLs（P〈0．01）；多重耐药的铜绿假单胞菌（multi—drug resistant Pesudomonas aeruginosa，MDRPA）检出率为40．3％（29／72），耐碳青霉烯的鲍曼不动杆菌（Carbapenems—resistant Acineto—bacterbaumannii，CA—Ab）的检出率为43．2％（41／95）。仅头孢哌酮／舒巴坦及阿米卡星有良好的敏感性（〉50％），而对其余绝大部分常用抗菌药物的耐药性相当严重。结论伤口感染以革兰阳性球菌为主，感染病原菌多为多重／泛耐药菌株，对常用抗菌药物甚至碳青霉烯类耐药性严重，应该引起高度重视，临床应据细菌药物敏感性试验报告选用抗菌药物。

Wound infection pathogens and drug resistance spectrum analysis

bstract： Objective To explore the common pathogens and their resistance to trauma patients wound infection, guide rational clinical therapy. Methods Retrospective analysis of 2010 - 2012 trauma patients infected wound secretions bacteria were cultured and drug sensitivity test. The main pathogens and drug resistance were analyszed. Results Isolated the bacteria in 1 086 strain, living in the first place of infection was Staphylococcus aureus （ 23.6% ）, followed by Escherichia coli （ 23. 2% ） , Klebsiella pneumonia （ 10. 2% ）, Acinetobacter baumanni （8.8%） ,Pseudomonas aeruginosa（ 6.6% ） ,isolated eight Candida albieans （0.7%） ; Methicillin-resistant Staphy- lococcus aureus （ meticillin-muhiple resistance S. aureus, MRSA） 71.5%. Main infected with Staphylococcus au- reus was a moreserious resistanee to other commonly used antibiotics except vancomyein, linezolid 100% sensitive. With MRSA resistance was significantly higher than MSSA （ P 〈 0.01 ）. Enterbacteriaceae produeing extended speetrum 3-]actamase strains （ESBL） detection rate was 64.5%. The ESBLs resistance than non-producing strains serious（P 〈0.01 ）. To quinolones, aminoglyeosides eommonly used in high resistanee rates. Muhi-drug resistant Pseudomonas aeruginosa （MDRPA） detection rate of 40.3 % , Carbapenem-resistant Acinetobaeter baumannii detec- tion （CA-Ab） rate of 43.2%. Only cefoperazone/sulbaetam and amikacin had good sensitivity（ 〉 50% ） ,while a majority of antimicrobial resistance is quite serious. Conclusion Wound infection pathogens are gram-positive bacteria. The infectious pathogens were muhipart/pan-resistant strains, and serious resistance to commonly used antibiotics, the clinical use of antimierobial drugs based on culture results and drug sensitivity test report.