CAJ | 학술논문

目的监测创伤感染患者伤口致病菌分布及对抗生素的敏感性,为临床合理应用抗生素提供依据. 方法细菌鉴定采用表型鉴定,极少数菌采用分子生物学鉴定.药敏试验采用最小抑菌浓度(minimum inhibitory concentration,MIC)微量稀释法或Kirby-Bauer纸片扩散法.结果 1 006例患者共检出121种1 257株致病菌,前10位菌占70.09％.革兰阳性球菌占48.93％,革兰阴性杆菌占49.72％.在金黄色葡萄球菌和表皮葡萄球菌中耐甲氧西林的菌株分别占34.76％和71.08％;未检出对万古霉素、利奈唑胺耐药的金黄色葡萄球菌和表皮葡萄球菌.在粪肠球菌中耐万古霉素肠球菌(vancomycin resistant enterococcal,VRE)检出率为6.06％,敏感率＞90％的抗生素依次为替考拉宁、氨苄青霉素及万古霉素.在屎肠球菌中VRE检出率为10.53％,替考拉宁敏感率＞90％,万古霉素敏感率＞80％.多重耐药鲍曼不动杆菌检出率为12.77％,敏感率＞70％的依次为亚胺培南、美罗培南.多重耐药鲍曼醋酸钙复合不动杆菌检出率为29.72％,敏感率＞50％的依次为亚胺培南、美罗培南.多重耐药铜绿假单胞菌检出率为3.73％,敏感率＞90％的依次为阿米卡星、美罗培南、亚胺培南及哌拉西林/他唑巴坦.未检出耐亚胺培南、美罗培南的大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌.大肠埃希菌中产超广谱β-内酰胺酶(extended-spectrum β-lactamases,ESBLs)菌株检出率为69.51％,哌拉西林/他唑巴坦敏感率＞90％,阿米卡星敏感率＞80％.肺炎克雷伯菌中产ESBLs株检出率为53.13％,阿米卡星敏感率＞80％. 结论创伤感染以常见菌为主,粪肠球菌和屎肠球菌均对替考拉宁敏感性最高;两种不动杆菌均对亚胺培南具有最高敏感性.
목적 감측창상감염환자상구치병균분포급대항생소적민감성,위림상합리응용항생소제공의거. 방법 세균감정채용표형감정,겁소수균채용분자생물학감정.약민시험채용최소억균농도(minimum inhibitory concentration,MIC)미량희석법혹Kirby-Bauer지편확산법.결과 1 006례환자공검출121충1 257주치병균,전10위균점70.09％.혁란양성구균점48.93％,혁란음성간균점49.72％.재금황색포도구균화표피포도구균중내갑양서림적균주분별점34.76％화71.08％;미검출대만고매소、리내서알내약적금황색포도구균화표피포도구균.재분장구균중내만고매소장구균(vancomycin resistant enterococcal,VRE)검출솔위6.06％,민감솔＞90％적항생소의차위체고랍저、안변청매소급만고매소.재시장구균중VRE검출솔위10.53％,체고랍저민감솔＞90％,만고매소민감솔＞80％.다중내약포만불동간균검출솔위12.77％,민감솔＞70％적의차위아알배남、미라배남.다중내약포만작산개복합불동간균검출솔위29.72％,민감솔＞50％적의차위아알배남、미라배남.다중내약동록가단포균검출솔위3.73％,민감솔＞90％적의차위아미잡성、미라배남、아알배남급고랍서림/타서파탄.미검출내아알배남、미라배남적대장애희균、폐염극뢰백균화음구장간균.대장애희균중산초엄보β-내선알매(extended-spectrum β-lactamases,ESBLs)균주검출솔위69.51％,고랍서림/타서파탄민감솔＞90％,아미잡성민감솔＞80％.폐염극뢰백균중산ESBLs주검출솔위53.13％,아미잡성민감솔＞80％. 결론 창상감염이상견균위주,분장구균화시장구균균대체고랍저민감성최고;량충불동간균균대아알배남구유최고민감성.
Objective To monitor the distribution of pathogenic bacteria causing wound infection in trauma patients and their susceptibility to antibiotics in an effort to offer evidence for the rational clinical use of antibiotics.Methods Pathogens were identified by expressive type,but a very few was determined by the molecular methods.Micro-dilution or Kirby-Bauer method for minimum inhibitory concentration (MIC) was adopted for drug susceptibility test.Results A total of 121 species of pathogens numbering 1,257 bacterial strains were isolated from 1,066 patients.Strain number of the top 10 species accounted for 70.09％.Gram-positive cocci accounted for 48.93％ and Gram-negative bacilli for 49.72％.Among Staphylococcus aureus and epidermidis,methicillin-resistant bacterial strains accounted for 34.76％ and 71.08％ respectively,but none were resistant to vancomycin or linezolid.Enterococcus faecalis contained 6.06％ vancomycin-resistant enterococcal (VRE) and remained ＞ 90％ sensitive to teicoplanin,ampicilin and vancomycin.Enterococcus faecium contained 10.53％ VRE and remained ＞90％ sensitive to teicoplanin and ＞ 80％ sensitive to vancomycin.Baumanii contained 12.77％ multidrug resistant strains and remained ＞ 70％ sensitive to imipenem and meropenem.Baumanii/calcoaceticus complex contained 29.72％ multi-drug resistant strains and remained ＞ 50％ sensitive to imipenem and meropenem.Pseudomonas aeruginosa contained 3.73％ multi-drug resistant strains and remained ＞90％ sensitive to amikacin,meropenem,imipenem and piperacillin/tazobactam.No E.coli,klebsiella pneumoniae and enterobacter cloacae resistant to imipenem or meropenem were found.E.coli contained 69.51％ extended-spectrum β-lactamases (ESBLs)-producing strains and remained ＞ 90％ sensitive to piperacillin/tazobactam and ＞ 80％ sensitive to amikacin.Klebsiella pneumoniae contained 53.13％ ESBLs-producing strains and remained ＞ 80％ sensitive to amikacin.Conclusions Common bacteria are the leading cause of posttraumatic infection.Enterococcus faecalis and enterococcus faecium demonstrate higher susceptibility to teicoplanin; two kinds of acinetobacter demonstrate higher susceptibility to imipenem.