不同类型创面病原菌定植和感染情况分析
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摘要
目的通过对不同类型创面病原菌定植和感染情况的分析,为临床治疗提供借鉴。方法对2013-2016年临床科室送检的病人创面分泌物细菌培养、鉴定、药敏试验结果和临床资料进行统计分析。结果难愈性创面和非难愈性创面中共采集分泌物478例次,分离出病原菌340株,其中71.76%为多重耐药菌。难愈性创面分泌物中病原菌多重耐药菌比例为77.96%,致病菌以革兰阴性菌为主;非难愈性创面分泌物中病原菌多重耐药菌比例为55.79%,致病菌以革兰阳性菌为主。本次住院超过2周是难愈性创面病原菌定植感染的独立危险因素。结论不同类型创面病原菌多重耐药菌比例均较高,而难愈性创面分泌物病原菌多重耐药菌尤为突出,应加强病人创面感染防控,尤其是难愈性创面的感染防控,以降低病原菌定植率。
Objective To provide reference for clinical treatment through the analysis of different types of wound pathogens colonization and infection.Methods Statistical analysis was performed on the results of bacterial culture,identification and drug susceptibility test as well as the clinical data of patients' wound secretions submitted by clinical departments from 2013 to2016.Results A total of 478 cases of secretions were collected from refractory wounds and non-refractory wounds,and 340 pathogenic bacteria were isolated,of which 71.76% were multi-drug resistant bacteria.The proportion of multi-drug resistant pathogens in refractory wound secretion was 77.96%,and Gram-negative bacteria were the main pathogenic bacteria.The proportion of multi-drug resistant pathogens in non-refractory wound secretion was 55.79% and Gram-positive bacteria were the main pathogens.The hospitalization of more than 2 weeks was an independent risk factor for refractory wound infections.Conclusion The proportion of multi-drug resistant bacteria in different types of wound pathogens was high,and the non-refractory wound secretion pathogens multi-drug resistant bacteria was prominent.Infection prevention and control of patients with wounds should be strengthened,especially for non-fractory wounds to reduce the rate of pathogen colonization.
Objective To provide reference for clinical treatment through the analysis of different types of wound pathogens colonization and infection.Methods Statistical analysis was performed on the results of bacterial culture,identification and drug susceptibility test as well as the clinical data of patients' wound secretions submitted by clinical departments from 2013 to2016.Results A total of 478 cases of secretions were collected from refractory wounds and non-refractory wounds,and 340 pathogenic bacteria were isolated,of which 71.76% were multi-drug resistant bacteria.The proportion of multi-drug resistant pathogens in refractory wound secretion was 77.96%,and Gram-negative bacteria were the main pathogenic bacteria.The proportion of multi-drug resistant pathogens in non-refractory wound secretion was 55.79% and Gram-positive bacteria were the main pathogens.The hospitalization of more than 2 weeks was an independent risk factor for refractory wound infections.Conclusion The proportion of multi-drug resistant bacteria in different types of wound pathogens was high,and the non-refractory wound secretion pathogens multi-drug resistant bacteria was prominent.Infection prevention and control of patients with wounds should be strengthened,especially for non-fractory wounds to reduce the rate of pathogen colonization.
引文
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[10]邱瑶雪,李家斌,程君,等.2013-2015革兰阴性多药耐药菌的分布、耐药性及危险因素分析[J].中华医院感染学杂志,2017,27(5):980-983.
[11]张艳.负压创面治疗技术应用于难愈性伤口的疗效分析[J].微创医学,2016,11(1):130-131.
[12]倪俊,许献荣.不同类型创面病原菌定植和感染差异性研究[J].中国消毒学杂志,2017,34(9):854-856.
[13]王爱田,刘向欣,高景利,等.多药耐药菌分布及耐药性分析[J].中华医院感染学杂志,2014,24(24):6012-6014.
[14]王锦,黄梅,王虹.多重耐药菌的临床分布特征和危险因素分析[J].中国卫生检验杂志,2014,24(24):3622-3624.
[15]夏晓君,荆俊丽,张凤春,等.临床抗感染治疗不足与耐药菌产生的相关研究[J].中华医院感染学杂志,2015,25(18):4172-4173.
[16]徐艳,杨怀,牟霞,等.多药耐药菌感染及定植患者信息精准化管理研究[J].中华医院感染学杂志,2016,26(11):2414-2417.
[2]郭海水,路远,吕海东,等.慢性难愈性创面综合治疗方法探讨[J].山西医药杂志,2014,43(9):1052-1054.
[3]JAMES GA,SWOGGER E,WOLCOTT R,et al.Biofilms in chronic wounds[J].Wound Repair Regen,2008,16(1):37-44.
[4]倪俊,许献荣.中药抗难愈性创面耐甲氧西林金黄色葡萄球菌研究进展[J].中国微生态学杂志,2015,27(9):1105-1110.
[5]倪俊,许献荣,陈瑞彩,等.创面感染多重耐药菌的分布及感染因素研究[J].中国消毒学杂志,2017,34(2):148-149.
[6]JAMES GA,SWOGGER E,WOLCOTT R,et al.Biofilms in chronic wounds[J].Wound Repair Regen,2008,16(1):37-44.
[7]李善友,郝岱峰,柴家科,等.难愈性创面细菌培养结果及药物敏感性分析[J].中华损伤与修复杂志(电子版),2014,9(4):66-68.
[8]郑旺,肖志波,王瑜,等.难愈创面的研究进展[J].中国临床保健杂志,2015,18(4):446-448.
[9]晁生武,李毅,刘宏,等.高原地区慢性难愈性创面感染常见致病菌监测及耐药性分析[J].中华损伤与修复杂志(电子版),2017,12(2):109-112.
[10]邱瑶雪,李家斌,程君,等.2013-2015革兰阴性多药耐药菌的分布、耐药性及危险因素分析[J].中华医院感染学杂志,2017,27(5):980-983.
[11]张艳.负压创面治疗技术应用于难愈性伤口的疗效分析[J].微创医学,2016,11(1):130-131.
[12]倪俊,许献荣.不同类型创面病原菌定植和感染差异性研究[J].中国消毒学杂志,2017,34(9):854-856.
[13]王爱田,刘向欣,高景利,等.多药耐药菌分布及耐药性分析[J].中华医院感染学杂志,2014,24(24):6012-6014.
[14]王锦,黄梅,王虹.多重耐药菌的临床分布特征和危险因素分析[J].中国卫生检验杂志,2014,24(24):3622-3624.
[15]夏晓君,荆俊丽,张凤春,等.临床抗感染治疗不足与耐药菌产生的相关研究[J].中华医院感染学杂志,2015,25(18):4172-4173.
[16]徐艳,杨怀,牟霞,等.多药耐药菌感染及定植患者信息精准化管理研究[J].中华医院感染学杂志,2016,26(11):2414-2417.