烧伤患者感染病原菌的分布及耐药性分析
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摘要
目的·调查烧伤患者感染病原菌的种类及耐药性,为临床合理应用抗菌药物、减少耐药株产生及医院感染控制提供依据。方法·收集2016年1月—2017年12月上海交通大学医学院附属瑞金医院烧伤患者送检标本的分离菌株,采用VITEK 2 Compact全自动微生物分析系统和K-B纸片扩散法进行药敏试验,统计送检标本类型、菌种类型及主要致病菌的药敏结果。通过χ2检验对比2016—2017年与前期研究中2013—2014年主要病原菌的检出率及耐药率的变化。结果·共检出病原菌1 053株,其中73.88%为创面来源;检出革兰阴性杆菌609株(57.83%)、革兰阳性球菌422株(40.08%)、真菌9株(0.85%)。革兰阴性杆菌最常检出为肺炎克雷伯菌(218株,20.70%),显著高于2013—2014年的检出率(114株,10.72%)(P=0.000);革兰阳性球菌最常检出为金黄色葡萄球菌(210株,19.94%),亦显著高于2013—2014年的检出率(200株,18.81%)(P=0.009)。肺炎克雷伯菌仅对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、亚胺培南、美罗培南、磷霉素和替加环素的耐药率低于60%,对氨苄西林和头孢唑啉的耐药率则高于90%,且对头孢他啶、头孢吡肟、亚胺培南、美罗培南和阿米卡星的耐药率明显高于2013—2014年的统计结果(P<0.05)。金黄色葡萄球菌对青霉素耐药率最高(94.63%),对万古霉素和利奈唑胺的敏感率为100%。耐甲氧西林金黄色葡萄球菌检出率为59.05%,与2013—2014年的检出率间差异无统计学意义(P=0.412)。结论·烧伤感染分离病原菌以肺炎克雷伯菌和金黄色葡萄球菌为主,且多重耐药性严重;管理干预及合理应用抗菌药物可控制耐药现象,及时定期监测患者病原菌的分布及耐药情况仍是控制预防院内感染的重要举措。
Objective · To provide guidance for the rational usage of antibiotics, reduction of drug-resistant strains and hospital infection control by investigating the distribution and drug resistance of pathogens isolated from burned patients. Methods · Isolates from burned patients of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine between Jan. 2016 and Dec. 2017 were collected. The VITEK 2 Compact automatic microbial analysis system and K-B disc diffusion method were used for antimicrobial susceptibility test. Statistical analysis was performed to investigate the type of specimens and strains and the resistance rates of major pathogens. Chi-square test was used to compare the changes of the detection rates and drug resistance rates of major pathogens between 2016-2017 and 2013-2014. Results · A total of 1 053 isolates were isolated, and most of them(73.88%)were from wounds. Among them, 609(57.83%) isolates were gram-negative bacilli(G-B), 422(40.08%) were gram-positive cocci(G+C) and 9(0.85%)were fungi. The most common pathogen of G-B was Klebsiella pneumoniae(218, 20.70%) in 2016-2017, the proportion of which was significantly higher than that in 2013-2014(114, 10.72%)(P=0.000). The most common pathogen of G+C was Staphylococcus aureus(210, 19.94%), the proportion of which was significantly higher than that in 2013-2014(200, 18.81%)(P=0.009). K. pneumoniae showed low resistance only to piperacillin/tazobactam,cefoperazone/sulbactam, imipenem, meropenem, fosfomycin and tigecycline(<60%), but high resistance to ampicillin and cefazolin(>90%). The resistance rates of K. pneumoniae to ceftazidime, cefepime, imipenem, meropenem and amikacin in 2016-2017 were significantly higher than those in 2013-2014(P<0.05). S. aureus was only resistant highly to penicillin(94.63%) and 100% susceptible to vancomycin and linezolid. The proportion of methicillin-resistant S. aureus(MRSA) was 59.05% in 2016-2017, which had no statistical difference compared with that in 2013-2014(P=0.412).Conclusion · The most two prevalent isolates from burned patients were K. pneumoniae and S. aureus with multi-drug resistance. Improved management and rational use of antibiotics can reduce the incidence of antibiotic resistant pathogens, and it's still important to keep routine surveillance on pathogens isolated from burned patients for control and prevention of nosocomial infections.
Objective · To provide guidance for the rational usage of antibiotics, reduction of drug-resistant strains and hospital infection control by investigating the distribution and drug resistance of pathogens isolated from burned patients. Methods · Isolates from burned patients of Ruijin Hospital,Shanghai Jiao Tong University School of Medicine between Jan. 2016 and Dec. 2017 were collected. The VITEK 2 Compact automatic microbial analysis system and K-B disc diffusion method were used for antimicrobial susceptibility test. Statistical analysis was performed to investigate the type of specimens and strains and the resistance rates of major pathogens. Chi-square test was used to compare the changes of the detection rates and drug resistance rates of major pathogens between 2016-2017 and 2013-2014. Results · A total of 1 053 isolates were isolated, and most of them(73.88%)were from wounds. Among them, 609(57.83%) isolates were gram-negative bacilli(G-B), 422(40.08%) were gram-positive cocci(G+C) and 9(0.85%)were fungi. The most common pathogen of G-B was Klebsiella pneumoniae(218, 20.70%) in 2016-2017, the proportion of which was significantly higher than that in 2013-2014(114, 10.72%)(P=0.000). The most common pathogen of G+C was Staphylococcus aureus(210, 19.94%), the proportion of which was significantly higher than that in 2013-2014(200, 18.81%)(P=0.009). K. pneumoniae showed low resistance only to piperacillin/tazobactam,cefoperazone/sulbactam, imipenem, meropenem, fosfomycin and tigecycline(<60%), but high resistance to ampicillin and cefazolin(>90%). The resistance rates of K. pneumoniae to ceftazidime, cefepime, imipenem, meropenem and amikacin in 2016-2017 were significantly higher than those in 2013-2014(P<0.05). S. aureus was only resistant highly to penicillin(94.63%) and 100% susceptible to vancomycin and linezolid. The proportion of methicillin-resistant S. aureus(MRSA) was 59.05% in 2016-2017, which had no statistical difference compared with that in 2013-2014(P=0.412).Conclusion · The most two prevalent isolates from burned patients were K. pneumoniae and S. aureus with multi-drug resistance. Improved management and rational use of antibiotics can reduce the incidence of antibiotic resistant pathogens, and it's still important to keep routine surveillance on pathogens isolated from burned patients for control and prevention of nosocomial infections.
引文
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[12]Sarhaddi N,Soleimanpour S,Farsiani H,et al.Elevated prevalence of multidrug-resistant Acinetobacter baumannii with extensive genetic diversity in the largest burn centre of northeast Iran[J].J Glob Antimicrob Resist,2017,8:60-66.
[13]糜琛蓉,倪语星,孙木,等.医院计算机网络在抗菌药物使用管理中的应用[J].中国医院管理,2011,31(4):61-62.
[2]王毅,郑德义,程代微,等.烧伤创面感染的病原菌分布与耐药性分析[J].中华医院感染学杂志,2015,25(24):5663-5665.
[3]高立平,易博,廖殿晓,等.烧伤科连续5年医院感染回顾性调查[J].中国感染控制杂志,2018,17(1):77-79.
[4]李红英,刘丽华,王静,等.烧伤创面病原菌感染的相关因素分析[J].中华医院感染学杂志,2017,27(2):345-347.
[5]徐正鹏,王粟,韩立中,等.烧伤住院患者感染病原菌的分布及耐药性分析[J].上海交通大学学报(医学版),2017,37(4):527-531.
[6]CLSI.M100S.Performance standards for antimicrobial susceptibility testing:26th edition[S].Wayne:Clinical and Laboratory Standards Institute,2016.
[7]Panghal M,Singh K,Kadyan S,et al.The analysis of distribution of multidrug resistant Pseudomonas and Bacillus species from burn patients and burn ward environment[J].Burns,2015,41(4):812-819.
[8]Wang S,Han LZ,Ni YX,et al.Changes in antimicrobial susceptibility of commonly clinically significant isolates before and after the interventions on surgical prophylactic antibiotics(SPAs)in Shanghai[J].Braz J Microbiol,2018,49(3):552-558.
[9]梁尊鸿,潘云川,徐家钦,等.烧伤患者医院感染病原菌分布及耐药变迁分析[J].中华损伤与修复杂志(电子版),2011,6(6):21-24.
[10]查彬彬.烧伤病房常见病原菌分布及耐药性分析[D].合肥:安徽医科大学,2015.
[11]Wang LF,Li JL,Ma WH,et al.Drug resistance analysis of bacterial strains isolated from burn patients[J].Genet Mol Res,2014,13(4):9727-9734.
[12]Sarhaddi N,Soleimanpour S,Farsiani H,et al.Elevated prevalence of multidrug-resistant Acinetobacter baumannii with extensive genetic diversity in the largest burn centre of northeast Iran[J].J Glob Antimicrob Resist,2017,8:60-66.
[13]糜琛蓉,倪语星,孙木,等.医院计算机网络在抗菌药物使用管理中的应用[J].中国医院管理,2011,31(4):61-62.