摘要
目的通过对1 216例骨科伤口分泌物样本分离病原菌分布情况及耐药性的分析,为临床骨科伤口感染治疗合理选用抗菌药物提供依据。方法对江油市人民医院2015年1月至2018年12月骨科送检的1 216例伤口分泌物标本进行培养分离,采用西门子SCAN4细菌鉴定系统对分离的病原菌继续细菌鉴定及药物敏感试验分析。结果 1 216例骨科伤口分泌物标本分离出主要病原菌474株,阳性率为38.98%。其中革兰阴性(G-)杆菌278株,占58.65%;革兰阳性(G+)球菌189株,占39.87%,7株为真菌,占1.48%。G-杆菌中位居前五位病原菌是大肠埃希菌(E.coli)、阴沟肠杆菌(AC)、肺炎克雷伯菌(KP)、鲍曼不动杆菌(BM)和铜绿假单胞菌(PA),分别占11.81%、9.49%、8.86%、7.17%和5.49%。G+球菌位居前三位病原菌是金黄色葡萄球菌(SA)、表皮葡萄球菌(SE)和溶血葡萄球菌(SH),分别占16.03%、10.76%和4.43%。E.coli和AC的药敏试验中均未发现耐亚胺培南和美洛培南的菌株产生。BM除对头孢唑林、复方新诺明、左氧氟沙星、头孢哌酮/舒巴坦和阿米卡星的耐药率在30.0%以下外,对其他抗菌药物的耐药率均在50.0%以上。PA除对复方新诺明和氨苄西林/舒巴坦的耐药率在90.0%以上外,对其他抗菌药物的耐药率均在25.0%以下。G+球菌对青霉素G耐药率最高达90.0%以上,其次对庆大霉素、左氧氟沙星、诺氟沙星、四环素、红霉素、苯唑西林和克林霉素耐药率也均在30.0%以上。结论骨科伤分泌物分离的病原菌呈多样化,种类多,耐药现象比较严重。临床应重视并及时开展骨科伤口分泌物的病原菌培养,临床医生根据药敏试验结果合理选用抗菌药物,能有效控制病原菌感染以及耐药菌株发生。
Objective To analyze the distribution and drug resistance of pathogenic bacteria isolated from 1 216 cases of wound secretions in orthopedics,so as to provide evidence for rational selection of antibiotics in the treatment of orthopedic wound infections.Methods 1 216 wound secretion specimens from orthopaedic department of Jiangyou People’s Hospital from January 2015 to December 2018 were cultured and separated.The pathogenic bacteria were identified by Siemens SCAN4 bacterial identification system and the drug sensitivity test was analyzed.Results 474 strains of main pathogenic bacteria were isolated from 1 216 cases of wound secretions of orthopaedics,and the positive rate was 38.98%.Among them,278 strains of Gram-negative(G-)bacilli accounted for 58.65%,189 strains of Gram-positive(G+)cocci accounted for 39.87%,and 7 strains of fungi accounted for 1.48%.The top five pathogens of G-bacilli were Escherichia coli(E.coli),Enterobacter cloacae(AC),KP,Acinetobacter baumannii(BM)and Pseudomonas aeruginosa(PA),accounting for 11.81%,9.49%,8.86%,7.17%and 5.49%respectively.The top three pathogens of G+cocci were Staphylococcus aureus(SA),Staphylococcus epidermidis(SE)and Staphylococcus hemolyticus(SH),accounting for 16.03%,10.76%and 4.43%respectively.No imipenem-resistant and meropenem-resistant strains were found in E.coli and AC susceptibility tests.The resistance rates of BM to cefazolin,compound trimethoprim,levofloxacin,cefoperazone/sulbactam and amikacin were below 30.0%,while the resistance rates to other antibiotics were above 50.0%.The resistance rate of PA to other antimicrobial agents was below 25.0%,except for compound trimethoprim and ampicillin/sulbactam,which were more than90.0%.The highest resistance rate of G+cocci to penicillin G was over 90.0%,followed by gentamicin,levofloxacin,norfloxacin,tetracycline,erythromycin,oxacillin and clindamycin.Conclusion The pathogenic bacteria isolated from orthopaedic wound secretions are diverse,various and drug-resistant.Clinicians should pay attention to and timely carry out the cultivation of pathogenic bacteria in wound secretion of orthopaedics.Clinicians can effectively control the pathogenic bacteria infection and the occurrence of drug-resistant bacteria by reasonably selecting antimicrobial agents according to the results of drug susceptibility test.
作者
陈玲
Chen Ling(Laboratory Department,Jiangyou People's Hospital,Sichuan Jiangyou 621700)
