CAJ | 학술논문

目的探讨地震伤患儿创面感染病原菌的分布和耐药情况.方法 2008年5月13日至6月12日,我院收治汶川地震伤患儿98例,对其临床诊断为创面感染的50例进行了创面分泌物分离培养,并就病原菌和耐药情况进行回顾性分析.结果在50例临床诊断为创面感染的患儿中,有31例创而分离培养出病原菌,阳性率62.0%;其中21例为混合感染,占67.7%.共分离培养出病原菌99株,革兰阳性菌16株(16.16%),革兰阴性菌81株(81.82%),真菌2株(2.02%).革兰阳性菌以金黄色葡萄球菌5株(5.05%)、粪肠球菌3株(3.03%)、屎肠球菌2株(2.02%)为主,革兰阴性菌中以鲍曼不动杆菌27株(27.27%)、阴沟肠杆菌18株(18.18%)、铜绿假单胞菌13株(13.13%)为主.鲍曼不动杆菌居检出病菌的首位,患儿的被困时间和并发症情况与感染该菌有明显相关性.药敏结果显示病原菌对常用抗生素耐药较为严重.1株鲍曼复合醋酸钙不动杆菌和6株鲍曼不动杆菌对包括泰能在内的所有常用抗生素耐药.革兰阳性菌对万古霉素仍敏感.结论地震伤患儿创面感染病原菌有所变化,以往分离率低的鲍曼不动杆菌反而成为主要的感染菌,产酶菌株多,细菌耐药率高,治疗困难.了解患儿创面感染病原菌的分布和耐药性情况,可指导临床合理用药,提高抢救成功率.
목적 탐토지진상환인창면감염병원균적분포화내약정황.방법 2008년5월13일지6월12일,아원수치문천지진상환인98례,대기림상진단위창면감염적50례진행료창면분비물분리배양,병취병원균화내약정황진행회고성분석.결과 재50례림상진단위창면감염적환인중,유31례창이분리배양출병원균,양성솔62.0%;기중21례위혼합감염,점67.7%.공분리배양출병원균99주,혁란양성균16주(16.16%),혁란음성균81주(81.82%),진균2주(2.02%).혁란양성균이금황색포도구균5주(5.05%)、분장구균3주(3.03%)、시장구균2주(2.02%)위주,혁란음성균중이포만불동간균27주(27.27%)、음구장간균18주(18.18%)、동록가단포균13주(13.13%)위주.포만불동간균거검출병균적수위,환인적피곤시간화병발증정황여감염해균유명현상관성.약민결과현시병원균대상용항생소내약교위엄중.1주포만복합작산개불동간균화6주포만불동간균대포괄태능재내적소유상용항생소내약.혁란양성균대만고매소잉민감.결론 지진상환인창면감염병원균유소변화,이왕분리솔저적포만불동간균반이성위주요적감염균,산매균주다,세균내약솔고,치료곤난.료해환인창면감염병원균적분포화내약성정황,가지도림상합리용약,제고창구성공솔.
Objective To investigate the distribution and the drug resistance pattern of pathogenic bacteria isolated from pediatric cases suffering from wounds infection following the Wenchuan earthquake. Methods Of the ninety-eight injured children, 50 had wound infection diagnosed by clinical examination. Specimens for culture were collected from the fifty injured children and the results of bacterial identification and antibiotic resistance were retrospectively reviewed. Results In the fifty injured children with wound infection, microbial growth was detected in 31 (62.0%) and 21 children suffered from mixed infections (the infection rate was 67.7%). Ninety-nine pathogens were isolated, gram positive bacteria accounted for 16.16% (16 strains), Gram negative bacteria accounted for 81.82% (81 strains), and fungus 2.02% (2 strains). Staphylococcus aureus (5 strains, 5.05%), Enterococcus faecalis (3 strains, 3.03%) and Enterococcus faecium (2 strains, 2.02%)were the primary Gram-positive bacteria identified and Gram-negative infections typically included Acinetobacter baumanii (27 strains, 27.27%), Enterobacter cloacae (18 strains, 18.18%)and Pseudomonas aeruginosa(13 strains, 13.13%). Acinetobacter baumanii was the most common organism isolated from wounds. Duration of being sieged and complications had a significant association with wound infection with Acinetobacter baumanii. Drug sensitivity tests displayed that the isolated bacteria were highly resistant to common antibiotics. One strain of Acinetobacter baumanii-calcoaceticus complex and six strains of Acinetobacter baumanii were resistant to all common antibiotics including imipenem/cilastatin. Vancomycin-resistant Gram-positive bacteria were not identified. Conclusion Following the Wenchuan earthquake disaster, wound infection profiles of pediatric patients were significantly different, Acinetobacter baumanii was the main common organism isolated from wounds in contrast to the previous low isolation rate. The isolated bacteria were highly and multiple drug resistant and it was difficult to treat. Knowing the distribution and the drug resistance pattern of pathogen is of paramount importance in guiding the clinical treatment.