摘要
目的探讨高原低氧环境下烧伤科患者创面普通培养细菌分布特点及耐药性,为高原烧伤科患者抗感染治疗提供参考依据。方法选取2018-2021年该院烧伤科患者的创面普通培养细菌阳性标本362份为研究对象。对分离菌株进行鉴定和药敏试验;分析患者创面的细菌分布特点;分析检出的主要革兰阳性菌及革兰阴性菌的耐药情况;分析2018-2021年各年检出的主要革兰阳性菌和革兰阴性菌分布及耐药率变化。结果普通培养细菌阳性的362份标本中,检出革兰阳性菌236株(65.19%),以金黄色葡萄球菌、表皮葡萄球菌占比较高(37.02%、12.98%);检出革兰阴性菌126株(34.81%),以大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌占比较高(11.60%、5.80%、5.25%)。金黄色葡萄球菌对青霉素、红霉素和克林霉素的耐药率较高,对左氧氟沙星、氯霉素、利福平的耐药率较低;分离出的金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌占65.67%。表皮葡萄球菌对青霉素、红霉素和克林霉素的耐药率较高;分离出的表皮葡萄球菌中,耐甲氧西林表皮葡萄球菌占70.21%。大肠埃希菌对头孢唑啉、氨苄西林和哌拉西林的耐药率较高,对亚胺培南和美罗培南不耐药。铜绿假单胞菌对头孢唑啉和哌拉西林的耐药率较高。肺炎克雷伯菌对头孢唑啉、哌拉西林和头孢噻肟的耐药率较高。2018-2021年,检出的表皮葡萄球菌和大肠埃希菌数量呈增多趋势。2018-2021年,金黄色葡萄球菌对环丙沙星、利福平的耐药率呈升高趋势,对青霉素的耐药率呈降低趋势;表皮葡萄球菌对庆大霉素、苯唑西林、红霉素、克林霉素、甲氧苄啶/磺胺异噁唑、四环素的耐药率呈降低趋势;大肠埃希菌对氨苄西林/舒巴坦的耐药率呈升高趋势;铜绿假单胞菌对头孢唑啉的耐药率呈降低趋势。结论高原低氧环境下烧伤科患者创面细菌感染特点和耐药性不同于平原地区,根据高原地区烧伤科患者的细菌鉴定及药敏试验结果早期采取有效的抗感染治疗措施具有重要意义。
Objective To explore the distribution characteristics and drug resistance analysis of general culture bacteria on burn wounds of patients in department of burn in plateau hypoxia environment to provide reference for anti-infective treatment of patients in department of burn in plateau area.Methods A total of 362 general culture bacteria positive samples from wounds of patients in department of burn of the Hospital from 2018 to 2021 were selected as the research objects.The isolated strains were identified and tested for drug susceptibility.The distribution characteristics of bacteria in the wounds of patients were analyzed.The drug resistance of the main Gram-positive bacteria and Gram-negative bacteria was analyzed.The distribution and drug resistance rate of the main Gram-positive and Gram-negative bacteria detected in each year from 2018 to 2021 were analyzed.Results Among the 362 samples positive for general culture,236 strains(65.19%)of Gram-positive bacteria were detected,with Staphylococcus aureus and Staphylococcus epidermidis accounting for the highest proportion(37.02%,12.98%),and 126 strains(34.81%)of Gram-negative bacteria were detected,among which Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae accounted for the highest proportion(11.60%,5.80%,5.25%).The drug resistance rates of Staphylococcus aureus to penicillin,erythromycin and clindamycin were high,and the drug resistance rates to levofloxacin,chloramphenicol and rifampicin were low.Among the isolated Staphylococcus aureus,the methicillin-resistant Staphylococcus aureus accounted for 65.67%.The drug resistance rate of Staphylococcus epidermidis to penicillin,erythromycin and clindamycin was high.Among the isolated Staphylococcus epidermidis,the methicillin-resistant Staphylococcus epidermidis accounted for 70.21%.Escherichia coli was resistant to cefazolin,ampicillin and piperacillin,but not to imipenem and meropenem.The resistance rate of Pseudomonas aeruginosa to cefazolin and piperacillin was high.The resistance rate of Klebsiella pneumoniae to cefazolin,piperacillin and cefotaxime was high.From 2018 to 2021,the number of Staphylococcus epidermidis and Escherichia coli showed an increasing trend.From 2018 to 2021,the drug resistance rate of Staphylococcus aureus to ciprofloxacin and rifampicin showed an increasing trend,while the drug resistance rate to penicillin showed a decreasing trend,the drug resistance rate of Staphylococcus epidermidis to gentamicin,oxacillin,erythromycin,clindamycin,trimethoprim/sulfamethoxazole and tetracycline showed a decreasing trend,the resistance rate of Escherichia coli to ampicillin/sulbactam showed an increasing trend,the resistance rate of Pseudomonas aeruginosa to cefazolin showed a decreasing trend.Conclusion The characteristics and drug resistance of wound bacterial infection of patients in department of burn in plateau hypoxia environment are different from those in plain areas.It is of great significance to take effective anti-infective treatment measures in early stage according to the bacterial identification and drug sensitivity test results of patients in department of burn in plateau area.
作者
于小惠
丁巳娟
何冲
冯东方
肖静
陈红
杨思思
徐欢
YU Xiaohui;DING Sijuan;HE Chong;FENG Dongfang;XIAO Jing;CHEN Hong;YANG Sisi;XU Huan(Department of Clinical Laboratory,The General Hospital of PLA Tibet Military Area Command,Lhasa,Tibet 850000,China;Department of Burn Plastic Surgery,The General Hospital of PLA Tibet Military Area Command,Lhasa,Tibet 850000,China)
出处
《国际检验医学杂志》
CAS
2022年第23期2841-2845,共5页
International Journal of Laboratory Medicine
基金
国家自然科学基金青年基金项目(82102517)
西藏自治区基地与人才计划项目(XZ202201JD0001G)。
关键词
细菌
耐药性
烧伤科
高原地区
低氧环境
bacterial
drug resistance
department of burn
plateau area
hypoxia environment
