烧伤患者难愈性创面多重耐药菌回顾性分析
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摘要
目的分析烧伤外科病房难愈性创面多重耐药菌(MDRO)定植感染情况,为临床感染防控提供依据。方法对2012年1月至2017年12月中国人民解放军海军第九〇五医院烧伤外科住院患者难愈性创面的细菌学资料进行调查,回顾性分析MDRO的分布、检出率及特殊耐药情况。结果难愈性创面分离出270株MDRO,其中革兰阳性菌128株(47.41%),革兰阴性菌142株(52.59%)。居前5位的MDRO依次为金黄色葡萄球菌(125株)、铜绿假单胞菌(56株)、大肠埃希菌(30株)、肺炎克雷伯菌(19株)和鲍曼不动杆菌(18株)。MDRO平均检出率为77.14%,以上前5位MDRO检出率分别为88.65%、65.12%、90.91%、100.00%和90.00%。特殊耐药菌株中,耐甲氧西林金黄色葡萄球菌共118株,碳青霉烯类耐药的铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌分别为42株、12株和5株。结论烧伤外科病房难愈性创面MDRO分布广泛、检出率高,应采取有效的感染防控措施。
Objective To investigate the multidrug resistance organism(MDRO) isolated from refractory wound in burns surgery wards, and to provide reference for prevention and control of refractory wound MDRO infection. Methods Refractory wound bacteriological data of patients who were treated in Burns Surgery Wards in the 905 th Hospital of PLA Navy from January 2011 to December 2017 were collected. The distribution and detection rate of MDRO, specific drug resistance organism were analyzed, retrospectively. Results There were270 MDRO strains isolated from refractory wound, among which Gram-positive and Gram-negative MDRO accounted for 47.41% and 52.59%, respectively. The top five MDRO strains were Staphylococcus aureus(125 strains), Pseudomonas aeruginosa(56 strains), Escherichia coli(30 strains), Klebsiella pneumoniae(19 strains)and Acinetobacter baumannii(18 strains). The average detection rate of MDRO was 77.14%. The detection rate of the above top five MDRO were 88.65%, 65.12%, 90.91%, 100.00% and 90.00%, respectively. Among those MDRO, there were 118 strains of methicillin-resistance Staphylococcus aureus(MRSA), 42 strains of carbapenem-resistance Pseudomonas aeruginosa(CR-PA), 12 strains of carbapenem-resistance Acinetobacter baumannii(CR-AB) and 5 strains of carbapenem-resistance Klebsiella pneumoniae(CR-KP), respectively.Conclusions MDRO isolated from refractory wound in burns surgery wards are diverse and the detection rates are high. Measures need to be strengthened for prevention and treatment of refractory wound MDRO infection.
Objective To investigate the multidrug resistance organism(MDRO) isolated from refractory wound in burns surgery wards, and to provide reference for prevention and control of refractory wound MDRO infection. Methods Refractory wound bacteriological data of patients who were treated in Burns Surgery Wards in the 905 th Hospital of PLA Navy from January 2011 to December 2017 were collected. The distribution and detection rate of MDRO, specific drug resistance organism were analyzed, retrospectively. Results There were270 MDRO strains isolated from refractory wound, among which Gram-positive and Gram-negative MDRO accounted for 47.41% and 52.59%, respectively. The top five MDRO strains were Staphylococcus aureus(125 strains), Pseudomonas aeruginosa(56 strains), Escherichia coli(30 strains), Klebsiella pneumoniae(19 strains)and Acinetobacter baumannii(18 strains). The average detection rate of MDRO was 77.14%. The detection rate of the above top five MDRO were 88.65%, 65.12%, 90.91%, 100.00% and 90.00%, respectively. Among those MDRO, there were 118 strains of methicillin-resistance Staphylococcus aureus(MRSA), 42 strains of carbapenem-resistance Pseudomonas aeruginosa(CR-PA), 12 strains of carbapenem-resistance Acinetobacter baumannii(CR-AB) and 5 strains of carbapenem-resistance Klebsiella pneumoniae(CR-KP), respectively.Conclusions MDRO isolated from refractory wound in burns surgery wards are diverse and the detection rates are high. Measures need to be strengthened for prevention and treatment of refractory wound MDRO infection.
引文
[1]倪俊,许献荣,陈瑞彩.难愈性创面感染的病原菌分布及定植感染相关因素[J/CD].中华实验和临床感染病学杂志(电子版),2018,12(1):35-39.
[2]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):151-152.
[3]王明贵.广泛耐药革兰阴性菌感染的实验诊断,抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-93.
[4]Magiorakos AP,Srinivasan A,Carey RB,et al.Multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance[J].Clin Microbiol Infect,2012,18(3):268-281.
[5]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[6]Clinton A,Carter T.Chronic Wound Biofilms:pathogenesis and potential therapies[J].Lab Med,2015,46(4):277-284.
[7]Morton LM,Phillips TJ.Wound healing and treating wounds:differential diagnosis and evaluation of chronic wounds[J].J Am Acad Dermatol,2016,74(4):589-605.
[8]Di Domenico EG,Farulla I,Prignano G,et al.Biofilm is a major virulence determinant in bacterial colonization of chronic skin ulcers independently from the multidrug resistant phenotype[J].Int J Mol Sci,2017,18(5):E1077.
[9]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.
[10]王盟.2012至2014年某三级综合医院住院患者多药耐药菌感染分析[J/CD].中华实验和临床感染病学杂志(电子版),2016,10(3):333-336.
[11]李耘,吕媛,薛峰,等.中国细菌耐药监测研究2013至2014年肠杆菌科及嗜血杆菌监测报告[J].中华检验医学杂志,2016,39(2):103-119.
[12]齐心,孙立颖,温冰,等.皮肤软组织感染的病原菌分布与耐药性分析[J].中国临床药理学杂志,2016,32(11):999-1003.
[13]冯保英,耿荣华.呼吸科多重耐药菌感染的相关因素及预防措施[J/CD].中华实验和临床感染病学杂志(电子版),2015,9(4):513-515.
[14]郭卫红,宋宏先,王娟,等.某院多重耐药菌菌群分布及耐药性分析[J/CD].中华实验和临床感染病学杂志(电子版),2016,10(6):716-720.
[15]李耘,吕媛,薛峰,等.中国细菌耐药监测研究2013至2014年革兰阳性菌监测报告[J].中华检验医学杂志,2016,39(2):120-129.
[16]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阳性菌监测报告[J].中国临床药理学杂志,2017,33(23):2543-2556.
[17]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[18]李耘,吕媛,薛峰,等.中国细菌耐药监测研究2013至2014年非发酵革兰阴性菌监测报告[J].中华检验医学杂志,2016,39(2):130-138.
[19]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.
[20]倪俊,顾海峰,许献荣,等.烧伤病房难愈性创面病原菌分布及耐药性分析[J].中国微生态学杂志,2013,25(2):184-186.
[21]Qin X,YangY,Hu F,et al.Hospital clonal dissemination of Enterobacter aerogenes producing carbapenemase KPC-2 in a Chinese teaching hospital[J].J Med Microbiol,2014,63(Pt2):222-228.
[22]Witte W,Cuny C,Klare I,et al.Emergence and spread of antibiotic-resistant Gram-positive bacterial pathogens[J].Int J Med Microbiol,2008,298(5-6):365-377.
[23]Timsit JF,Soubirou JF,Voiriot G,et al.Treatment of bloodstream infections in ICUs[J].BMC Infect Dis,2014,14:489.
[24]徐必生,袁华兵,杨萍.某三级综合医院多重耐药菌相关感染经济负担评估[J/CD].中华实验和临床感染病学杂志(电子版),2017,11(5):455-459.
[25]Tam VH,Rogers CA,Chang KT,et al.Impact of multidrug-resistant Pseudomonas aeruginosa bacteremia on patient outcomes[J].Antimicrob Agents Chemother,2010,54(9):3717-3722.
[26]van Langeveld I,Gagnon RC,Conrad PF,et al.Multiple-drug resistance in burn patients:a retrospective study on theimpact of antibiotic resistance on survival and length of stay[J].J Burn Care Res,2017,38(2):99-105.
[2]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):151-152.
[3]王明贵.广泛耐药革兰阴性菌感染的实验诊断,抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-93.
[4]Magiorakos AP,Srinivasan A,Carey RB,et al.Multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance[J].Clin Microbiol Infect,2012,18(3):268-281.
[5]胡付品,朱德妹,汪复,等.2015年CHINET细菌耐药性监测[J].中国感染与化疗杂志,2016,16(6):685-694.
[6]Clinton A,Carter T.Chronic Wound Biofilms:pathogenesis and potential therapies[J].Lab Med,2015,46(4):277-284.
[7]Morton LM,Phillips TJ.Wound healing and treating wounds:differential diagnosis and evaluation of chronic wounds[J].J Am Acad Dermatol,2016,74(4):589-605.
[8]Di Domenico EG,Farulla I,Prignano G,et al.Biofilm is a major virulence determinant in bacterial colonization of chronic skin ulcers independently from the multidrug resistant phenotype[J].Int J Mol Sci,2017,18(5):E1077.
[9]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.
[10]王盟.2012至2014年某三级综合医院住院患者多药耐药菌感染分析[J/CD].中华实验和临床感染病学杂志(电子版),2016,10(3):333-336.
[11]李耘,吕媛,薛峰,等.中国细菌耐药监测研究2013至2014年肠杆菌科及嗜血杆菌监测报告[J].中华检验医学杂志,2016,39(2):103-119.
[12]齐心,孙立颖,温冰,等.皮肤软组织感染的病原菌分布与耐药性分析[J].中国临床药理学杂志,2016,32(11):999-1003.
[13]冯保英,耿荣华.呼吸科多重耐药菌感染的相关因素及预防措施[J/CD].中华实验和临床感染病学杂志(电子版),2015,9(4):513-515.
[14]郭卫红,宋宏先,王娟,等.某院多重耐药菌菌群分布及耐药性分析[J/CD].中华实验和临床感染病学杂志(电子版),2016,10(6):716-720.
[15]李耘,吕媛,薛峰,等.中国细菌耐药监测研究2013至2014年革兰阳性菌监测报告[J].中华检验医学杂志,2016,39(2):120-129.
[16]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阳性菌监测报告[J].中国临床药理学杂志,2017,33(23):2543-2556.
[17]胡付品,郭燕,朱德妹,等.2016年中国CHINET细菌耐药性监测[J].中国感染与化疗杂志,2017,17(5):481-491.
[18]李耘,吕媛,薛峰,等.中国细菌耐药监测研究2013至2014年非发酵革兰阴性菌监测报告[J].中华检验医学杂志,2016,39(2):130-138.
[19]李耘,吕媛,郑波,等.中国细菌耐药监测研究2015-2016革兰氏阴性菌监测报告[J].中国临床药理学杂志,2017,33(23):2521-2542.
[20]倪俊,顾海峰,许献荣,等.烧伤病房难愈性创面病原菌分布及耐药性分析[J].中国微生态学杂志,2013,25(2):184-186.
[21]Qin X,YangY,Hu F,et al.Hospital clonal dissemination of Enterobacter aerogenes producing carbapenemase KPC-2 in a Chinese teaching hospital[J].J Med Microbiol,2014,63(Pt2):222-228.
[22]Witte W,Cuny C,Klare I,et al.Emergence and spread of antibiotic-resistant Gram-positive bacterial pathogens[J].Int J Med Microbiol,2008,298(5-6):365-377.
[23]Timsit JF,Soubirou JF,Voiriot G,et al.Treatment of bloodstream infections in ICUs[J].BMC Infect Dis,2014,14:489.
[24]徐必生,袁华兵,杨萍.某三级综合医院多重耐药菌相关感染经济负担评估[J/CD].中华实验和临床感染病学杂志(电子版),2017,11(5):455-459.
[25]Tam VH,Rogers CA,Chang KT,et al.Impact of multidrug-resistant Pseudomonas aeruginosa bacteremia on patient outcomes[J].Antimicrob Agents Chemother,2010,54(9):3717-3722.
[26]van Langeveld I,Gagnon RC,Conrad PF,et al.Multiple-drug resistance in burn patients:a retrospective study on theimpact of antibiotic resistance on survival and length of stay[J].J Burn Care Res,2017,38(2):99-105.