中华临床感染病杂志
中華臨床感染病雜誌
중화림상감염병잡지
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
2013年
2期
104-107
,共4页
伤口%感染%骨科%病原菌%抗药性
傷口%感染%骨科%病原菌%抗藥性
상구%감염%골과%병원균%항약성
Wound%Infection%Orthopedics%Pathogens%Drug resistance
目的 分析骨科患者伤口感染病原菌的分布及对抗菌药物的耐药性.方法 连续收集2010年7月至2012年6月河北医科大学第三医院骨科999例住院患者伤口分离出的病原菌,进行菌株鉴定,并采用纸片扩散法进行药敏试验.采用双向纸片法确证超广谱β-内酰胺酶(ESBLs)检测,耐甲氧西林金黄色葡萄球菌(MRSA)检测以头孢西丁纸片法判定.采用WHONET 5.4软件作耐药率统计.结果 999例患者的感染伤口中共分离出无重复病原菌1056株,其中革兰阴性菌739株(69.98％),革兰阳性菌304株(28.79％),真菌13株(1.23％).主要病原菌依次为金黄色葡萄球菌(265株,25.09％),铜绿假单胞菌(245株,23.20％),鲍曼不动杆菌(199株,18.84％)和大肠埃希菌(86株,8.14％)等.革兰阴性菌中,铜绿假单胞菌对头孢哌酮/舒巴坦、环丙沙星、左氧氟沙星和哌拉西林/他唑巴坦的耐药率较低,分别为13.58％,21.25％,21.67％和22.45％,但对复方磺胺甲(口恶)唑的耐药率较高,为98.04％.鲍曼不动杆菌除对头孢哌酮/舒巴坦的耐药率为14.29％外,对其他抗菌药物的耐药率均较高,其泛耐药菌株的检出率为5.53％(11/199).肠杆菌科细菌对亚胺培南和美罗培南全部敏感,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦和阿米卡星的敏感性亦较高,耐药率介于1.16％～28.12％.大肠埃希菌和肺炎克雷伯菌中产ESBLs菌株的检出率分别为48.84％ (42/86)和34.38％(11/32).革兰阳性菌中,金黄色葡萄球菌对万古霉素、替考拉宁和利奈唑胺均敏感,但对氨苄西林、青霉素G和红霉素的耐药率很高,分别为100.00％,99.25％和80.06％；MRSA的检出率为41.51％(110/265).肠球菌对红霉素、利福平、左氧氟沙星、高浓度庆大霉素、米诺环素和呋喃妥因的耐药率较高,对替考拉宁和利奈唑胺全部敏感,万古霉素中介株的检出率为4.55％ (1/22).结论 骨科患者伤口感染病原菌种类复杂,以金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、阴沟肠杆菌等为主,且多为多重耐药菌株.
目的 分析骨科患者傷口感染病原菌的分佈及對抗菌藥物的耐藥性.方法 連續收集2010年7月至2012年6月河北醫科大學第三醫院骨科999例住院患者傷口分離齣的病原菌,進行菌株鑒定,併採用紙片擴散法進行藥敏試驗.採用雙嚮紙片法確證超廣譜β-內酰胺酶(ESBLs)檢測,耐甲氧西林金黃色葡萄毬菌(MRSA)檢測以頭孢西丁紙片法判定.採用WHONET 5.4軟件作耐藥率統計.結果 999例患者的感染傷口中共分離齣無重複病原菌1056株,其中革蘭陰性菌739株(69.98％),革蘭暘性菌304株(28.79％),真菌13株(1.23％).主要病原菌依次為金黃色葡萄毬菌(265株,25.09％),銅綠假單胞菌(245株,23.20％),鮑曼不動桿菌(199株,18.84％)和大腸埃希菌(86株,8.14％)等.革蘭陰性菌中,銅綠假單胞菌對頭孢哌酮/舒巴坦、環丙沙星、左氧氟沙星和哌拉西林/他唑巴坦的耐藥率較低,分彆為13.58％,21.25％,21.67％和22.45％,但對複方磺胺甲(口噁)唑的耐藥率較高,為98.04％.鮑曼不動桿菌除對頭孢哌酮/舒巴坦的耐藥率為14.29％外,對其他抗菌藥物的耐藥率均較高,其汎耐藥菌株的檢齣率為5.53％(11/199).腸桿菌科細菌對亞胺培南和美囉培南全部敏感,對頭孢哌酮/舒巴坦、哌拉西林/他唑巴坦和阿米卡星的敏感性亦較高,耐藥率介于1.16％～28.12％.大腸埃希菌和肺炎剋雷伯菌中產ESBLs菌株的檢齣率分彆為48.84％ (42/86)和34.38％(11/32).革蘭暘性菌中,金黃色葡萄毬菌對萬古黴素、替攷拉寧和利奈唑胺均敏感,但對氨芐西林、青黴素G和紅黴素的耐藥率很高,分彆為100.00％,99.25％和80.06％；MRSA的檢齣率為41.51％(110/265).腸毬菌對紅黴素、利福平、左氧氟沙星、高濃度慶大黴素、米諾環素和呋喃妥因的耐藥率較高,對替攷拉寧和利奈唑胺全部敏感,萬古黴素中介株的檢齣率為4.55％ (1/22).結論 骨科患者傷口感染病原菌種類複雜,以金黃色葡萄毬菌、銅綠假單胞菌、鮑曼不動桿菌、大腸埃希菌、陰溝腸桿菌等為主,且多為多重耐藥菌株.
목적 분석골과환자상구감염병원균적분포급대항균약물적내약성.방법 련속수집2010년7월지2012년6월하북의과대학제삼의원골과999례주원환자상구분리출적병원균,진행균주감정,병채용지편확산법진행약민시험.채용쌍향지편법학증초엄보β-내선알매(ESBLs)검측,내갑양서림금황색포도구균(MRSA)검측이두포서정지편법판정.채용WHONET 5.4연건작내약솔통계.결과 999례환자적감염상구중공분리출무중복병원균1056주,기중혁란음성균739주(69.98％),혁란양성균304주(28.79％),진균13주(1.23％).주요병원균의차위금황색포도구균(265주,25.09％),동록가단포균(245주,23.20％),포만불동간균(199주,18.84％)화대장애희균(86주,8.14％)등.혁란음성균중,동록가단포균대두포고동/서파탄、배병사성、좌양불사성화고랍서림/타서파탄적내약솔교저,분별위13.58％,21.25％,21.67％화22.45％,단대복방광알갑(구악)서적내약솔교고,위98.04％.포만불동간균제대두포고동/서파탄적내약솔위14.29％외,대기타항균약물적내약솔균교고,기범내약균주적검출솔위5.53％(11/199).장간균과세균대아알배남화미라배남전부민감,대두포고동/서파탄、고랍서림/타서파탄화아미잡성적민감성역교고,내약솔개우1.16％～28.12％.대장애희균화폐염극뢰백균중산ESBLs균주적검출솔분별위48.84％ (42/86)화34.38％(11/32).혁란양성균중,금황색포도구균대만고매소、체고랍저화리내서알균민감,단대안변서림、청매소G화홍매소적내약솔흔고,분별위100.00％,99.25％화80.06％；MRSA적검출솔위41.51％(110/265).장구균대홍매소、리복평、좌양불사성、고농도경대매소、미낙배소화부남타인적내약솔교고,대체고랍저화리내서알전부민감,만고매소중개주적검출솔위4.55％ (1/22).결론 골과환자상구감염병원균충류복잡,이금황색포도구균、동록가단포균、포만불동간균、대장애희균、음구장간균등위주,차다위다중내약균주.
Objective To determine the distribution and drug resistance of pathogens isolated from wounds in orthopedic patients.Methods Wound samples were collected from 999 orthopedic patients in the Third Hospital of Hebei Medical University during July 2010 and June 2012.Pathogens were isolated and identified.The antimicrobial susceptibility test was performed by Kirby-Bauer method.Extended spectrum β-1actamases (ESBLs) were detected by double-disk diffusion test,and methicillin-resistant Staphylococcus aureus (MRSA) was detected by cefoxitin disk diffusion test.WHONET 5.4 was used for drug resistance analysis.Results A total of 1056 strains of pathogens were isolated,of which gram-positive cocci,gramnegative organisms and fungi accounted for 69.98％ (739/1056),28.79％ (304/1056),and 1.23％(13/1056),respectively.The top 5 pathogens were Staphylococcus aureus (265.25.09％).Pseudomonas aeruginosa (245,23.20％),Acinetobacter baumannii (199,18.84％) and Escherichia coli (86,8.14％).The resistant rates of Pseudomonas aeruginosa to cefoperazone/sulbactam,ciprofloxacin,levofloxacin and piperacillin/tazobactam were 13.58％,21.25％,21.67％ and 22.45％,while the highest resistance rate was to compound sulfamethoxazole (98.04％).Acinetobacter baumannii was highly resistant to most antibacterial agents except cefoperazone/sulbactam (14.29％),and 11 out of 199 strains were pandrug resistant.Enterobacteriaceae were completely susceptible to imipenem and meropenem,and their resistance rates to cefoperazone/sulbactam,piperacillin/tazobactam and amikacin were 1.16％-28.12％.ESBLs positive rates of Escherichia coli and Klebsiella pneumoniae were 48.84％ (42/86) and 34.38％(11/32),respectively.Staphylococcus aureus were susceptible to vancomycin,teicoplanin and linezolid,but were highly resistant to ampicillin (100.00％),penicillin G (99.25％) and erythromycin (80.06％).The rate of MRSA was 41.51％ (110/265).Enterococcus were highly resistant to erythromycin,rifampin,levofloxacin,high-concentration gentamicin,minocycline and nitrofurantoin,but were susceptible to teicoplanin and linezolid,and the rate of vancomycin intermediate strain was 4.55％ (1/22).Conclusions The pathogens of wound infections in orthopedic patients were of wide variety.Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Enterobacter cloacae were the most prevalent pathogens,and most strains were multi-drug resistant.
