福建地区复杂性皮肤软组织感染的病原学及药敏分析
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摘要
目的:探讨本地区复杂性皮肤软组织感染(SSTI)的病原菌分布和主要致病菌对抗菌药物的敏感性变化,指导复杂性皮肤软组织感染的抗生素使用及临床经验用药。
方法:回顾性分析2005年4月到2009年2月期间福建医科大学附属第一医院住院的137例皮肤软组织感染患者的资料,记录患者的年龄、性别、现病史、外伤史、既往疾病史、临床诊断、取材部位、致病菌培养及药物敏感性的结果、治疗,对资料利用SPSS13.0进行统计分析。
结果:本研究组共137例,其中男104例,女33例。年龄1～87岁,平均42.2岁。共检出100株病原菌,其中G+细菌51株(社区获得性感染为25株,医院感染为26株),G-细菌49株(社区获得性感染为24株,医院感染为25株)。
所有分离所得的G+细菌中,葡萄球菌属是主要致病菌,该菌属对红霉素、青霉素G、氯洁霉素、苯唑西林、左氧氟沙星表现有较高的耐药性,对替考拉宁、万古霉素、力奈唑烷、夫西地酸、莫西沙星敏感性较好。社区获得性感染对SMZ、四环素、环丙沙星敏感性高于医院感染的葡萄球菌(P<0.05,差别有统计学意义)。分离所得的G-细菌中,铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌等为主要的致病菌。G-杆菌对左氧氟沙星、SMZ、庆大霉素有较高的耐药性,对碳青霉烯类如亚胺培南、美罗培南,妥布霉素、哌拉西林-他唑巴坦敏感性较好。社区获得性感染对左氧氟沙星、亚胺培南、美罗培南的敏感性高于医院感染的革兰阴性杆菌(P<0.05,差别有统计学意义)。
发现耐甲氧西林的金黄色葡萄球菌(MRSA)共21例,其中社区获得性SSTI(CA-SSTI)分离得到的MRSA(CA-MRSA)共9例。另外,在社区获得性感染中,发现对万古霉素中介的MRSA 1株(VISA)。
结论:本地区复杂性皮肤软组织感染的主要G+病原菌为葡萄球菌,CA-MRSA感染有上升的趋势,发现社区获得性VISA的菌株。铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌等为主要的G-致病菌。住院治疗复杂性皮肤软组织感染的G+细菌经验性用药可选用左氧氟沙星、环丙沙星、夫西地酸、莫西沙星、万古霉素药物。G-细菌经验性用药可选用环丙沙星、氨曲南、头孢吡肟、哌拉西林-他巴唑坦、妥布霉素、亚胺培南、美罗培南药物。
Objective To investigate pathogens and sensitivity to antimicrobial agents in complicated skin and soft-tissue infection in this area.To guide antibiotics use in complicated skin and soft-tissue infection in this area.
Methods A retrospective study was made in the first affiliated hospital of fujian medical university, from April,2005 to Feb,2009.The patients developed complicated skin and soft tissue infection. Age,sexuality, present symptom,trauma history,past history,clinical diagnosis, sampling part,the pathogenic bacteria , antimicrobial susceptibility test and therapy were recorded. Statistic was analyzed by SPSS of vesion 13.0 software.
Results There were 137 patients in this series:104 males,33 females,age 1-87year,mean age 42.2year.100 bacteria were isolated, including 51 Gram-positive bacteria(25 of community- associated,26 of hospital- acquired) and 49 Gram-negative bacteria(24 of community- associated,25 of hospital- acquired). Staphylococcus was the majoy Gram-positive pathogenic bacteria to skin and soft- tissue infection. Most of Staphylococcus was resistant to erythromycin, penicillin,clin- damycin , oxacillin and Levofloxacin and more sensitive to teicoplanin,vancomycin, linezolid,fusidic acid and moxifloxacin. Community- associated staphylococcus was more sensitive to SMZ,Tetracycline and cipr- ofloxacin than hospital-acquired staphylococcus.Pseudomonas Aeruginosa , Klebsiella pneumonia , Escherichia Coli and Acinetobacter Baumannii was the main Gram-negative pathogenic bacterium.Most of these bacterium was resistant to Levofloxacin, SMZ , gentamicin and more sensitive to lmipenem, meropenem,tobramycin, poperacillin-tazobactam. Community-associated bacilli was more sensitive to Levofloxacin, lmipenem ,meropenem than hospital-acquired bacilli.21 MRSA was isolated in the study,including 9 community-associated MRSA. one MRSA was found intermediate-sensitive to vancomycin(VISA).
Conclusion Staphylococcus was the majoy Gram-positive pathogenic bacterium of complicated skin and soft-tissue infection in this area and the prevalence of community-associated MRSA ,VISA was found. Pseudomonas Aeruginosa , Klebsiella pneumonia , Escherichia Coli and Acinetobacter Baumannii was tha main Gram-negative pathogenic bacterium. According to the observations of this study,the first selection of antibiotics for treating complicated skin and soft-tissue infections should be : levofloxacin , Ciprofloxacinfusidic acid,moxifloxacin , vancomycin for the Gram-positive infection,and Ciprofloxacin, cefepime, aztreonam ,tobramycin,lmipenem,meropenem, poperacillin-tazobactam for Gram-negative infection.
方法:回顾性分析2005年4月到2009年2月期间福建医科大学附属第一医院住院的137例皮肤软组织感染患者的资料,记录患者的年龄、性别、现病史、外伤史、既往疾病史、临床诊断、取材部位、致病菌培养及药物敏感性的结果、治疗,对资料利用SPSS13.0进行统计分析。
结果:本研究组共137例,其中男104例,女33例。年龄1～87岁,平均42.2岁。共检出100株病原菌,其中G+细菌51株(社区获得性感染为25株,医院感染为26株),G-细菌49株(社区获得性感染为24株,医院感染为25株)。
所有分离所得的G+细菌中,葡萄球菌属是主要致病菌,该菌属对红霉素、青霉素G、氯洁霉素、苯唑西林、左氧氟沙星表现有较高的耐药性,对替考拉宁、万古霉素、力奈唑烷、夫西地酸、莫西沙星敏感性较好。社区获得性感染对SMZ、四环素、环丙沙星敏感性高于医院感染的葡萄球菌(P<0.05,差别有统计学意义)。分离所得的G-细菌中,铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌等为主要的致病菌。G-杆菌对左氧氟沙星、SMZ、庆大霉素有较高的耐药性,对碳青霉烯类如亚胺培南、美罗培南,妥布霉素、哌拉西林-他唑巴坦敏感性较好。社区获得性感染对左氧氟沙星、亚胺培南、美罗培南的敏感性高于医院感染的革兰阴性杆菌(P<0.05,差别有统计学意义)。
发现耐甲氧西林的金黄色葡萄球菌(MRSA)共21例,其中社区获得性SSTI(CA-SSTI)分离得到的MRSA(CA-MRSA)共9例。另外,在社区获得性感染中,发现对万古霉素中介的MRSA 1株(VISA)。
结论:本地区复杂性皮肤软组织感染的主要G+病原菌为葡萄球菌,CA-MRSA感染有上升的趋势,发现社区获得性VISA的菌株。铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌等为主要的G-致病菌。住院治疗复杂性皮肤软组织感染的G+细菌经验性用药可选用左氧氟沙星、环丙沙星、夫西地酸、莫西沙星、万古霉素药物。G-细菌经验性用药可选用环丙沙星、氨曲南、头孢吡肟、哌拉西林-他巴唑坦、妥布霉素、亚胺培南、美罗培南药物。
Objective To investigate pathogens and sensitivity to antimicrobial agents in complicated skin and soft-tissue infection in this area.To guide antibiotics use in complicated skin and soft-tissue infection in this area.
Methods A retrospective study was made in the first affiliated hospital of fujian medical university, from April,2005 to Feb,2009.The patients developed complicated skin and soft tissue infection. Age,sexuality, present symptom,trauma history,past history,clinical diagnosis, sampling part,the pathogenic bacteria , antimicrobial susceptibility test and therapy were recorded. Statistic was analyzed by SPSS of vesion 13.0 software.
Results There were 137 patients in this series:104 males,33 females,age 1-87year,mean age 42.2year.100 bacteria were isolated, including 51 Gram-positive bacteria(25 of community- associated,26 of hospital- acquired) and 49 Gram-negative bacteria(24 of community- associated,25 of hospital- acquired). Staphylococcus was the majoy Gram-positive pathogenic bacteria to skin and soft- tissue infection. Most of Staphylococcus was resistant to erythromycin, penicillin,clin- damycin , oxacillin and Levofloxacin and more sensitive to teicoplanin,vancomycin, linezolid,fusidic acid and moxifloxacin. Community- associated staphylococcus was more sensitive to SMZ,Tetracycline and cipr- ofloxacin than hospital-acquired staphylococcus.Pseudomonas Aeruginosa , Klebsiella pneumonia , Escherichia Coli and Acinetobacter Baumannii was the main Gram-negative pathogenic bacterium.Most of these bacterium was resistant to Levofloxacin, SMZ , gentamicin and more sensitive to lmipenem, meropenem,tobramycin, poperacillin-tazobactam. Community-associated bacilli was more sensitive to Levofloxacin, lmipenem ,meropenem than hospital-acquired bacilli.21 MRSA was isolated in the study,including 9 community-associated MRSA. one MRSA was found intermediate-sensitive to vancomycin(VISA).
Conclusion Staphylococcus was the majoy Gram-positive pathogenic bacterium of complicated skin and soft-tissue infection in this area and the prevalence of community-associated MRSA ,VISA was found. Pseudomonas Aeruginosa , Klebsiella pneumonia , Escherichia Coli and Acinetobacter Baumannii was tha main Gram-negative pathogenic bacterium. According to the observations of this study,the first selection of antibiotics for treating complicated skin and soft-tissue infections should be : levofloxacin , Ciprofloxacinfusidic acid,moxifloxacin , vancomycin for the Gram-positive infection,and Ciprofloxacin, cefepime, aztreonam ,tobramycin,lmipenem,meropenem, poperacillin-tazobactam for Gram-negative infection.
引文
1.朱学骏,郑志忠,等。皮肤及软组织感染诊断及治疗共识[J]。中国医学论坛报,2008,E04:1-4.
2.SHUKLA SK .Community-associated methicillin-resistant Staphylococcs aureus and its emerging virulence[J].Clin Med Res,2005,3(2):57-60.
3.Fridkin SK,Hageman JC,Morrison M, et al. Methicillin-resistant Staphylococcs aureus disease in three communities[J].N Engl J Med,2005,352(14):1436-44.
4.Sievert DM, Boulton ML, Stoltman G, et al . Staphylococcus aureus to vancomycin-United States [J] ,2002. MMWR 2002,51(26):567.
5.Chang, S., D. M. Sievert, J. C. Hageman, et al. Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene[J]. N. Engl.J. Med. 2003 ,348:1342-1347.
6.Tiwari HK,Sen MR.Emergence of vancomycin resistant Staphylococcus aureus(VRSA) from a Tertiary care hospital from northern part of India[J]. BMC Infect . 2006,Dis6:156
7.Hossam M,Ashour , Amany El-Sharif.Microbial Spectrum and Antibiotic Susceptibility Profile of Gram-Positive Aerobic Bacteria Isolated From Cancer Patients.[J]. Clin. Oncol., Dec 2007, 25: 5763 - 5769.
8.严洲平,翟军青,周杰华。皮肤软组织感染分离菌的分布及耐药性[J]。中国皮肤性病学杂志2003,17(2):105-106.
9.中华人民共和国卫生部。医院感染诊断标准(试行)[J]。中华医学杂志,2001, 81(5):314-320.
10.舒敏,万朝敏。耐甲氧西林金黄色葡萄球菌的社区感染[J],西部医学,2008,20(1):200-202.
11.纪冰,马筱玲,胡白,等。57例门诊皮肤软组织感染细菌的分布及药物敏感性分析[J]。安徽医科大学学报,2006,41(5):604-605.
12.罗光浦,黄琼,翁孟武。118例天疱疮患者临床分析[J]。临床皮肤科杂志,2008,37(1):23-24.
13.Hossam M. Ashour ,Amany El-Sharif. Microbial spectrum and antibiotic susceptibility profile of Gram-positive aerobic bacteria isolated from cancer patients[J], J.Clin.Oncol.,Dec 2007,25:5763-5769.
14.杜秀。几种常见的医院感染病原菌分布。临床医药实践杂志[J],2006,15(2):132-133
15.Cynthia L. Maree,Robert S. Daum,Susan Boyle-Vavra,et al. Community-Associated Methicillin-Resistant Staphylococcus Aureus Isolates Causing Healthcare-Associated Infections[J]. Emerg Infect Dis. 2007,13(2):236-242.
16.GJ Moran, RN Amii, FM Abrahamian, et al .Methicillin-resistant Staphylococcus aureus in community-acquired skin infections[J]. Emerg Infect Dis, Jun 2005, 11(6): 928-30.
17.M Tinelli, A Pantosti, C Lusardi, et al. First detected case of community-acquired methicillin-resistant Staphylococcus aureus skin andsoft tissue infection in Italy[J].Euro Surveill, Apr 2007, 12(4): E070412.1.
18.Centers for Disease Control and Prevention. Outbreak of community-associated methicillin-resistant Staphylococcus aureus skin infections—Los Angeles County, California, 2002–2003[J]. MMWR Morb Mortal Wkly Rep. 2003,52:88.
19.Baquero,F.Gram-positive resistance:challenge for the development of new antibiotics[J].Journal of Antimicrobial Chemotherapy.1997,39:1-6.
20.Fuda C,Suvorov M,Vakulenko SB,et al. The basis for resistance to beta-lactam antibiotics by penicillin-binding protein 2a of methicilin-resistant Staphylococcus aureus[J]. J Biol Chem,2004,279(39):40802-40806.
21.Tenover FC. Development and spread of bacterial resistance to antimicrobial agents: an overview[J].Clin Infect Dis,2001,33(3):108-115.
22.Hiramastsu,K.,Hanaki, H.,Ino, T.,et al. Methicillin-resistant Staphylococcus aureus with reduced vancomyciin susceptibility[J]. Journal of Antimicrobial Chemotherapy.1997,40:135-136.
23.Centers for Disease Control and Prevention.Staphylococcus aureus with reduced susceptibillity to vancomycin-United States,1997[J].Morbidity and Mortality Weekly Report.1997,46:765-766.
24.Ronald Lee Nichols.Optimal treatment of complicated skin and skin structure infecions[J]. Journal of Antimicrobial Chemotherpay. 1999,44:19-23.
25.林燕青,邱卡仪,陈梅英。阴沟肠杆菌的分布及耐药性变迁[J]。中华医院感染学杂志, 2009, (04) :461-462.
26.李兴禄,黄长武,马珺。产气肠杆菌阴沟肠杆菌沙雷菌AmpC酶检测及耐药性分析[J]。重庆医学,2006,(03):137-139.
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3.Fridkin SK,Hageman JC,Morrison M, et al. Methicillin-resistant Staphylococcs aureus disease in three communities[J].N Engl J Med,2005,352(14):1436-44.
4.Sievert DM, Boulton ML, Stoltman G, et al . Staphylococcus aureus to vancomycin-United States [J] ,2002. MMWR 2002,51(26):567.
5.Chang, S., D. M. Sievert, J. C. Hageman, et al. Infection with vancomycin-resistant Staphylococcus aureus containing the vanA resistance gene[J]. N. Engl.J. Med. 2003 ,348:1342-1347.
6.Tiwari HK,Sen MR.Emergence of vancomycin resistant Staphylococcus aureus(VRSA) from a Tertiary care hospital from northern part of India[J]. BMC Infect . 2006,Dis6:156
7.Hossam M,Ashour , Amany El-Sharif.Microbial Spectrum and Antibiotic Susceptibility Profile of Gram-Positive Aerobic Bacteria Isolated From Cancer Patients.[J]. Clin. Oncol., Dec 2007, 25: 5763 - 5769.
8.严洲平,翟军青,周杰华。皮肤软组织感染分离菌的分布及耐药性[J]。中国皮肤性病学杂志2003,17(2):105-106.
9.中华人民共和国卫生部。医院感染诊断标准(试行)[J]。中华医学杂志,2001, 81(5):314-320.
10.舒敏,万朝敏。耐甲氧西林金黄色葡萄球菌的社区感染[J],西部医学,2008,20(1):200-202.
11.纪冰,马筱玲,胡白,等。57例门诊皮肤软组织感染细菌的分布及药物敏感性分析[J]。安徽医科大学学报,2006,41(5):604-605.
12.罗光浦,黄琼,翁孟武。118例天疱疮患者临床分析[J]。临床皮肤科杂志,2008,37(1):23-24.
13.Hossam M. Ashour ,Amany El-Sharif. Microbial spectrum and antibiotic susceptibility profile of Gram-positive aerobic bacteria isolated from cancer patients[J], J.Clin.Oncol.,Dec 2007,25:5763-5769.
14.杜秀。几种常见的医院感染病原菌分布。临床医药实践杂志[J],2006,15(2):132-133
15.Cynthia L. Maree,Robert S. Daum,Susan Boyle-Vavra,et al. Community-Associated Methicillin-Resistant Staphylococcus Aureus Isolates Causing Healthcare-Associated Infections[J]. Emerg Infect Dis. 2007,13(2):236-242.
16.GJ Moran, RN Amii, FM Abrahamian, et al .Methicillin-resistant Staphylococcus aureus in community-acquired skin infections[J]. Emerg Infect Dis, Jun 2005, 11(6): 928-30.
17.M Tinelli, A Pantosti, C Lusardi, et al. First detected case of community-acquired methicillin-resistant Staphylococcus aureus skin andsoft tissue infection in Italy[J].Euro Surveill, Apr 2007, 12(4): E070412.1.
18.Centers for Disease Control and Prevention. Outbreak of community-associated methicillin-resistant Staphylococcus aureus skin infections—Los Angeles County, California, 2002–2003[J]. MMWR Morb Mortal Wkly Rep. 2003,52:88.
19.Baquero,F.Gram-positive resistance:challenge for the development of new antibiotics[J].Journal of Antimicrobial Chemotherapy.1997,39:1-6.
20.Fuda C,Suvorov M,Vakulenko SB,et al. The basis for resistance to beta-lactam antibiotics by penicillin-binding protein 2a of methicilin-resistant Staphylococcus aureus[J]. J Biol Chem,2004,279(39):40802-40806.
21.Tenover FC. Development and spread of bacterial resistance to antimicrobial agents: an overview[J].Clin Infect Dis,2001,33(3):108-115.
22.Hiramastsu,K.,Hanaki, H.,Ino, T.,et al. Methicillin-resistant Staphylococcus aureus with reduced vancomyciin susceptibility[J]. Journal of Antimicrobial Chemotherapy.1997,40:135-136.
23.Centers for Disease Control and Prevention.Staphylococcus aureus with reduced susceptibillity to vancomycin-United States,1997[J].Morbidity and Mortality Weekly Report.1997,46:765-766.
24.Ronald Lee Nichols.Optimal treatment of complicated skin and skin structure infecions[J]. Journal of Antimicrobial Chemotherpay. 1999,44:19-23.
25.林燕青,邱卡仪,陈梅英。阴沟肠杆菌的分布及耐药性变迁[J]。中华医院感染学杂志, 2009, (04) :461-462.
26.李兴禄,黄长武,马珺。产气肠杆菌阴沟肠杆菌沙雷菌AmpC酶检测及耐药性分析[J]。重庆医学,2006,(03):137-139.
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