CAJ | 학술논문

目的：了解开放性骨折患者伤口分泌物病原菌检出情况及其耐药性,以指导临床治疗。方法对某院2012年5月-2013年7月1472例开放性骨折患者清创前后伤口分泌物标本进行病原菌培养和鉴定,以及药敏试验。结果清创前,1472例患者的分泌物标本中,1246例(84.65%)培养阳性,共检出病原菌2246株,其中824例(55.98%)检出2种及以上菌株。实施清创术后8 h,195例(13.25%)患者标本培养阳性,检出病原菌201株。Gustilo分型中,伤情越严重者病原培养阳性率越高。创面培养阳性率,清创前各分型患者均>50%；清创后,Ⅰ型、Ⅱ型与ⅢA型患者均<5%,而ⅢB和ⅢC型患者仍较高。金黄色葡萄球菌、表皮葡萄球菌对万古霉素敏感,对呋喃妥因耐药率<5%,对青霉素 G、红霉素高度耐药(耐药率>75%)；鲍曼不动杆菌对多种抗菌药物具有较强的耐药性,即使较为敏感的头孢哌酮/舒巴坦耐药率也达20%；铜绿假单胞菌对亚胺培南耐药率为10.80%,对头孢哌酮/舒巴坦、头孢吡肟、头孢他啶也较为敏感。结论对开放性骨折患者及时清创能明显减少创面病原菌；病原菌的药敏试验结果有助于指导临床合理用药。
목적：료해개방성골절환자상구분비물병원균검출정황급기내약성,이지도림상치료。방법대모원2012년5월-2013년7월1472례개방성골절환자청창전후상구분비물표본진행병원균배양화감정,이급약민시험。결과청창전,1472례환자적분비물표본중,1246례(84.65%)배양양성,공검출병원균2246주,기중824례(55.98%)검출2충급이상균주。실시청창술후8 h,195례(13.25%)환자표본배양양성,검출병원균201주。Gustilo분형중,상정월엄중자병원배양양성솔월고。창면배양양성솔,청창전각분형환자균>50%；청창후,Ⅰ형、Ⅱ형여ⅢA형환자균<5%,이ⅢB화ⅢC형환자잉교고。금황색포도구균、표피포도구균대만고매소민감,대부남타인내약솔<5%,대청매소 G、홍매소고도내약(내약솔>75%)；포만불동간균대다충항균약물구유교강적내약성,즉사교위민감적두포고동/서파탄내약솔야체20%；동록가단포균대아알배남내약솔위10.80%,대두포고동/서파탄、두포필우、두포타정야교위민감。결론대개방성골절환자급시청창능명현감소창면병원균；병원균적약민시험결과유조우지도림상합리용약。
Objective To realize the detection of pathogens and antimicrobial resistance of pathogens isolated from wound secretion in patients with open fractures,so as to guide clinical treatment.Methods 1 472 patients with open fractures from May 2012 to July 2013 were selected from a hospital,pathogens from wound secretions before and after debridement were identified and performed antimicrobial susceptibility testing.Results Before debride-ment,1 246 of 1 472 patients (84.65%)were isolated 2 246 bacterial strains,824 (55.98%)of patients were isola-ted at least 2 kinds of bacteria.Eight hours after debridement,201 pathogenic bacteria were isolated from 195 pa-tients (13.25%).The more serious of Gustilo type,the higher the positive rate of bacterial culture.Positive rate of wound culture were all >50% in patients of all Gustilo types before debridement;positive rate were all <5% in pa-tients of type I,Ⅱ and ⅢA,but type ⅢB and ⅢC were still high after debridement.Staphylococcus aureus and Staphylococcus epidermidis were sensitive to vancomycin,the resistant rates to furantoin were <5%,the resistant rates to penicillin G and erythromycin were all >75%.Acinetobacter baumannii had higher resistance to multiple antimicrobial agents,to cefoperazone/sulbactam was 20%;Pseudomonas aeruginosa to imipenem was 10.80%, sensitivity to cefoperazone/sulbactam,cefepime and ceftazidime were all higher.Conclusion For patients with open fractures,timely debridement can reduce wound pathogen,antimicrobial susceptibility testing result is helpful for guiding rational antimicrobial use.