烧伤整形外科1963株细菌及其耐药情况分析
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摘要
目的:分析烧伤整形外科细菌感染及其耐药情况,为临床合理使用抗生素提供依据。方法:收集2013年1月至2017年12月广西医科大学第一附属医院烧伤整形外科烧伤住院患者1 643例,共收集4 785份标本,采用WHONET5.6软件统计分析标本中病原菌分布及抗生素耐药情况。结果:4 785份送检标本中,培养出1 855株细菌,阳性率38.76%,其中创面分泌物标本细菌分离率占72.72%。在分离菌中,G-菌主要为鲍曼不动杆菌、铜绿假单胞菌等,占77.84%;G+菌为金黄色葡萄球菌、肠球菌和溶血性葡萄球菌,占22.16%。鲍曼不动杆菌对替加环素和米诺环素较敏感,对头孢唑林、氨苄西林等几乎全部耐药;铜绿假单胞菌对多黏菌素B耐药率低,对阿米卡星、左氧氟沙星、美罗培南和哌拉西林/他唑巴坦耐药率为26%～31%,对氨苄西林、头孢曲松等几乎全部耐药;大肠埃希菌对碳青霉烯类抗生素、哌拉西林/他唑巴坦和阿米卡星耐药率低,对氨苄西林、头孢唑林等的耐药率高达79%;肺炎克雷伯菌对碳青霉烯类抗生素、阿米卡星、哌拉西林/他唑巴坦耐药率低,对氨苄西林全部耐药;阴沟肠杆菌对碳青霉烯类、阿米卡星、哌拉西林/他唑巴坦和左氧氟沙星耐药率低,对头孢唑林、头孢呋辛和头孢西丁几乎全部耐药。金黄色葡萄球菌、肠球菌和溶血性葡萄球菌对替考拉宁、利奈唑胺、替加环素耐药率低,对红霉素、苯唑西林和四环素耐药率均非常高。结论:烧伤整形外科病原菌以G-杆菌为主,细菌耐药率高,尤其是鲍曼不动杆菌和铜绿假单胞菌耐药,且出现对碳青霉烯类抗生素耐药现象,应该引起重视。
Objective:To analyzed the condition of bacterial infection and drug resistance in Department of Burn Plastic Surgery,and to guide the proper use of antibiotics.Methods:From January 2013 to December2017,4,785 bacteriological specimens were collected from the burn and plastic surgery ward of our hospital.The pathogenic bacteria distribution and antibiotic resistance of 1,963 positive specimens were analyzed by WHONET5.6 software.Results:Of the 4,785 specimens,1,855 bacteria were cultured,and the positive rate of bacteria culture was 38.76%,which wound secretion specimens bacteria separation rate accounts for72.72% of total specimens bacteria separation rate.In isolated bacteria,Gram-negative bacteria mainly included Acinetobacter baumannii,Pseudomonas aeruginosa,etc.(77.84%).Gram-positive bacteria mainly included Staphylococcus aureus,Enterococcus and Staphylococcus hemolyticus(22.16%).The relatively sensitive antibiotics for Acinetobacter baumannii were tigacycline and minocycline,and almost all of them were resisted to cefazolin,ampicillin,etc.The most sensitive antibiotics of Pseudomonas aeruginosa was colistin B.The resistance rates to amikacin,levofloxacin,meropenem and piperacillin/tazobactam ranged from 26%to 31%,and almost all of them were resistant to ampicillin,ceftriaxone,etc.The more sensitive antibiotics of Escherichia coli were penicillium carbon alkene antibiotics,piperacillin/tazobactin and amikacin.The drug resistance rate to ampicillin,cefazolin,etc.was up to 79%.The more sensitive antibiotics of Klebsiella pneumoniae were penicillium carbon alkene antibiotics,amikacin,piperacillin/tazobactin,but all of them were resistant to ampicillin.The more sensitive antibiotics of Enterobacter cloacae were penicillium carbon alkene antibiotics,amikacin,piperacillin/tazobactin and levofloxacin,and almost all of them were resistant to cefazolin,cefuroxime and ceficidin.The antibiotics sensitive to Staphylococcus aureus,Enterococcus and Staphylococcus haemolyticus were tigacycline,linazolamide and tigecycline,however,the drug resistance rates to erythromycin,benzocillin and tetracycline were very high.Conclusion:The main pathogenic bacteria in the plastic surgery ward of burns were Gram-negative bacteria.Bacterial resistance was very serious,especially for Acinetobacter aumannii and Pseudomonas aeruginosa,this two strains were also resistant to carbapenems antibiotics,which should be paid attention to.
Objective:To analyzed the condition of bacterial infection and drug resistance in Department of Burn Plastic Surgery,and to guide the proper use of antibiotics.Methods:From January 2013 to December2017,4,785 bacteriological specimens were collected from the burn and plastic surgery ward of our hospital.The pathogenic bacteria distribution and antibiotic resistance of 1,963 positive specimens were analyzed by WHONET5.6 software.Results:Of the 4,785 specimens,1,855 bacteria were cultured,and the positive rate of bacteria culture was 38.76%,which wound secretion specimens bacteria separation rate accounts for72.72% of total specimens bacteria separation rate.In isolated bacteria,Gram-negative bacteria mainly included Acinetobacter baumannii,Pseudomonas aeruginosa,etc.(77.84%).Gram-positive bacteria mainly included Staphylococcus aureus,Enterococcus and Staphylococcus hemolyticus(22.16%).The relatively sensitive antibiotics for Acinetobacter baumannii were tigacycline and minocycline,and almost all of them were resisted to cefazolin,ampicillin,etc.The most sensitive antibiotics of Pseudomonas aeruginosa was colistin B.The resistance rates to amikacin,levofloxacin,meropenem and piperacillin/tazobactam ranged from 26%to 31%,and almost all of them were resistant to ampicillin,ceftriaxone,etc.The more sensitive antibiotics of Escherichia coli were penicillium carbon alkene antibiotics,piperacillin/tazobactin and amikacin.The drug resistance rate to ampicillin,cefazolin,etc.was up to 79%.The more sensitive antibiotics of Klebsiella pneumoniae were penicillium carbon alkene antibiotics,amikacin,piperacillin/tazobactin,but all of them were resistant to ampicillin.The more sensitive antibiotics of Enterobacter cloacae were penicillium carbon alkene antibiotics,amikacin,piperacillin/tazobactin and levofloxacin,and almost all of them were resistant to cefazolin,cefuroxime and ceficidin.The antibiotics sensitive to Staphylococcus aureus,Enterococcus and Staphylococcus haemolyticus were tigacycline,linazolamide and tigecycline,however,the drug resistance rates to erythromycin,benzocillin and tetracycline were very high.Conclusion:The main pathogenic bacteria in the plastic surgery ward of burns were Gram-negative bacteria.Bacterial resistance was very serious,especially for Acinetobacter aumannii and Pseudomonas aeruginosa,this two strains were also resistant to carbapenems antibiotics,which should be paid attention to.
引文
[1] CHURCH D,ELSAYED S,REID O,et al.Burn wound infections[J].Clin Microbiol Rev,2006,19(2):403-434.
[2] NORBURY W,HERNDON D N,TANKSLEY J,et al.Infection in burns[J].Surg Infect,2016,17(2):250-255.
[3] TAO L,ZHOU J,GONG Y,et al.Risk factors for centralline associated bloodstream infection in patients with major burns and the ef-ficacyofthetopical application of mupirocin at the central venouscatheter exit site[J].Burns,2015,41(8):1931-1838.
[4]付妍婕,于凤娜,刘荣朋,等.2015-2016年烧伤科住院患者感染细菌分布及耐药性分析[J].山东医学高等专科学校学报,2018,40(1):5-9.
[5]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.
[6] KEEN E F,ROBINSON B J,HOSPENTHAL D R,et al.Prevalence of multidrug-resistant organisms recovered at a military burn[J].Burns,2010,36(6):819-825.
[7]李平,范会,金炎,等.2010-2014年烧伤患者感染病原菌及抗菌药物敏感性分析[J].临床军医杂志,2016,44(12):1285-1287.
[8]谷振阳,高春记,赵莎莎,等.血流感染鲍曼不动杆菌的临床分布与耐药性分析[J].中华医院感染学杂志,2015,25(7):1448-1450.
[9]黄晓琴,郇京宁.烧伤患者耐药鲍曼不动杆菌感染的抗菌药物选择[J].上海交通大学学报(医学版),2012,32(6):815-819.
[10]龚雅利,杨子晨,殷素鹏,等.162例严重烧伤血流感染患者病原学特征分析[J].中华烧伤杂志,2016,32(9):529-535.
[11]周颖杰,施耀国.多黏菌素B治疗耐多药病原菌研究进展[J].国际药学研究杂志,2008,35(4):291-294.
[12]袁喆,张婷婷,王纯睿.多黏菌素B治疗多重耐药革兰阴性菌的新策略[J].西部医学,2017,29(1):4-12.
[13]孟鑫,尚德静.铜绿假单胞菌产生耐药性的机制[J].中国生化药物杂志,2016,12(36):200-204.
[14]黄加铭,范春梅,黄东红,等.2013年—2016年主要革兰阴性菌的耐药性变迁[J].基层医学论坛,2017,21(25):3331-3333.
[15]张秋,吴文汉.阴沟肠杆菌临床分布特征与耐药情况[J].中国消毒学杂志,2017,34(3):290-292.
[16]邓正泊.阴沟肠杆菌临床分布特征及耐药性变迁[J].诊断学理论与实践,2013,12(4):448-451.
[17]邵海鑫,魏莲花,刘刚,等.549株阴沟肠杆菌的临床分布及耐药性分析[J].世界最新医学信息文摘,2017,17(18):11-12.
[18]陈娟,姜俊.2010-2012年烧伤科住院患者感染细菌耐药监测分析[J].国际检验医学杂志,2014,35(1):111-113.
[19]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,2017,37(4):527-531.
[20]宋新刚,马爱矿,朱维平.某院烧伤病房2011-2014年细菌分布及耐药情况[J].现代医药卫生,2016,32(5):794-796.
[2] NORBURY W,HERNDON D N,TANKSLEY J,et al.Infection in burns[J].Surg Infect,2016,17(2):250-255.
[3] TAO L,ZHOU J,GONG Y,et al.Risk factors for centralline associated bloodstream infection in patients with major burns and the ef-ficacyofthetopical application of mupirocin at the central venouscatheter exit site[J].Burns,2015,41(8):1931-1838.
[4]付妍婕,于凤娜,刘荣朋,等.2015-2016年烧伤科住院患者感染细菌分布及耐药性分析[J].山东医学高等专科学校学报,2018,40(1):5-9.
[5]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.
[6] KEEN E F,ROBINSON B J,HOSPENTHAL D R,et al.Prevalence of multidrug-resistant organisms recovered at a military burn[J].Burns,2010,36(6):819-825.
[7]李平,范会,金炎,等.2010-2014年烧伤患者感染病原菌及抗菌药物敏感性分析[J].临床军医杂志,2016,44(12):1285-1287.
[8]谷振阳,高春记,赵莎莎,等.血流感染鲍曼不动杆菌的临床分布与耐药性分析[J].中华医院感染学杂志,2015,25(7):1448-1450.
[9]黄晓琴,郇京宁.烧伤患者耐药鲍曼不动杆菌感染的抗菌药物选择[J].上海交通大学学报(医学版),2012,32(6):815-819.
[10]龚雅利,杨子晨,殷素鹏,等.162例严重烧伤血流感染患者病原学特征分析[J].中华烧伤杂志,2016,32(9):529-535.
[11]周颖杰,施耀国.多黏菌素B治疗耐多药病原菌研究进展[J].国际药学研究杂志,2008,35(4):291-294.
[12]袁喆,张婷婷,王纯睿.多黏菌素B治疗多重耐药革兰阴性菌的新策略[J].西部医学,2017,29(1):4-12.
[13]孟鑫,尚德静.铜绿假单胞菌产生耐药性的机制[J].中国生化药物杂志,2016,12(36):200-204.
[14]黄加铭,范春梅,黄东红,等.2013年—2016年主要革兰阴性菌的耐药性变迁[J].基层医学论坛,2017,21(25):3331-3333.
[15]张秋,吴文汉.阴沟肠杆菌临床分布特征与耐药情况[J].中国消毒学杂志,2017,34(3):290-292.
[16]邓正泊.阴沟肠杆菌临床分布特征及耐药性变迁[J].诊断学理论与实践,2013,12(4):448-451.
[17]邵海鑫,魏莲花,刘刚,等.549株阴沟肠杆菌的临床分布及耐药性分析[J].世界最新医学信息文摘,2017,17(18):11-12.
[18]陈娟,姜俊.2010-2012年烧伤科住院患者感染细菌耐药监测分析[J].国际检验医学杂志,2014,35(1):111-113.
[19]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,2017,37(4):527-531.
[20]宋新刚,马爱矿,朱维平.某院烧伤病房2011-2014年细菌分布及耐药情况[J].现代医药卫生,2016,32(5):794-796.