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
2014年
2期
125-132
,共8页
高伟%童向民%黄印启%王鹏%范剑
高偉%童嚮民%黃印啟%王鵬%範劍
고위%동향민%황인계%왕붕%범검
医院,骨科%伤口感染%病原菌%抗药性
醫院,骨科%傷口感染%病原菌%抗藥性
의원,골과%상구감염%병원균%항약성
Hospital,orthopedic%Wound infection%Pathogen%Drug resistance
目的 探讨骨科患者伤口病原菌的分布及对抗菌药物的耐药性变迁.方法 连续收集2008年1月至2012年12月河北医科大学第三医院骨科住院患者伤口分离的病原菌资料,菌株鉴定应用法国生物梅里埃公司Vitek 32鉴定系统,药敏试验采用K-B法,采用线性趋势,检验分析病原菌分布及对抗菌药物的耐药性变迁.结果 5年间共分离出病原菌2 456株,其中革兰阴性杆菌1 652株(67.26％),革兰阳性球菌777株(31.64％),真菌26株(1.06％),革兰阳性杆菌l株(0.04％);居前5位的病原菌依次是金黄色葡萄球菌(666株,27.12％)、铜绿假单胞菌(606株,24.67％)、鲍曼不动杆菌(355株,14.45％)、大肠埃希菌(188株,7.65％)和阴沟肠杆菌(187株,7.61％).5年中,鲍曼不动杆菌的检出率呈上升趋势(x2=35.266,P＜0.01).鲍曼不动杆菌中泛耐药株的检出率为6.20％(22/355),铜绿假单胞菌中泛耐药株的检出率为0.17％(1/606),大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶菌株的检出率分别为39.89(％(75/188)和29.23％(19/65),金黄色葡萄球菌中耐甲氧西林(MRSA)的检出率为40.69％(271/666),凝固酶阴性葡萄球菌中耐甲氧西林株的总检出率为52.38％ (22/42),肠球菌中万古霉素中介株的检出率为3.70％(2/54).MRSA的检出率呈上升趋势(x2=18.317,P＜0.01).金黄色葡萄球菌对替考拉宁、万古霉素和利奈唑胺均敏感;对利福平和阿米卡星的耐药率(11.29％ ～ 33.33％)较低;对青霉素类和红霉素的耐药率(76.80％ ～ 100.00％)很高;对头孢唑啉、头孢呋辛、头孢西丁、阿米卡星、左氧氟沙星的耐药率呈上升趋势(P＜0.05);对复方磺胺甲噁唑的耐药率(28.11％ ～48.35％)呈下降趋势(P＜0.01).铜绿假单胞菌对亚胺培南、美罗培南、复方磺胺甲噁唑的耐药率呈上升趋势(P＜0.05);对环丙沙星、左氧氟沙星、阿米卡星、庆大霉素、哌拉西林/他唑巴坦的耐药率呈下降趋势(P＜0.05);对头孢哌酮/舒巴坦的耐药率(9.15％～20.51％)最低.鲍曼不动杆菌对亚胺培南、美罗培南、左氧氟沙星、哌拉西林/他唑巴坦、复方磺胺甲噁唑的耐药率均呈上升趋势(P＜0.01);对头孢哌酮/舒巴坦的耐药率(11.86％ ～ 19.70％)最低.大肠埃希菌和阴沟肠杆菌对亚胺培南、美罗培南均敏感,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率(0 ～ 14.29％)较低;大肠埃希菌对哌拉西林、头孢吡肟、阿米卡星、左氧氟沙星、头孢哌酮/舒巴坦的耐药率均呈下降趋势(P＜0.05);阴沟肠杆菌对头孢西丁的耐药率呈上升趋势(P＜0.01),对哌拉西林、头孢他啶、头孢哌酮、头孢曲松、左氧氟沙星的耐药率均呈下降趋势(P＜0.05).结论 2008至2012年河北医科大学第三医院骨科患者伤口感染病原菌以金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌和阴沟肠杆菌为主,主要病原菌对常用抗菌药物的耐药性普遍较高.
目的 探討骨科患者傷口病原菌的分佈及對抗菌藥物的耐藥性變遷.方法 連續收集2008年1月至2012年12月河北醫科大學第三醫院骨科住院患者傷口分離的病原菌資料,菌株鑒定應用法國生物梅裏埃公司Vitek 32鑒定繫統,藥敏試驗採用K-B法,採用線性趨勢,檢驗分析病原菌分佈及對抗菌藥物的耐藥性變遷.結果 5年間共分離齣病原菌2 456株,其中革蘭陰性桿菌1 652株(67.26％),革蘭暘性毬菌777株(31.64％),真菌26株(1.06％),革蘭暘性桿菌l株(0.04％);居前5位的病原菌依次是金黃色葡萄毬菌(666株,27.12％)、銅綠假單胞菌(606株,24.67％)、鮑曼不動桿菌(355株,14.45％)、大腸埃希菌(188株,7.65％)和陰溝腸桿菌(187株,7.61％).5年中,鮑曼不動桿菌的檢齣率呈上升趨勢(x2=35.266,P＜0.01).鮑曼不動桿菌中汎耐藥株的檢齣率為6.20％(22/355),銅綠假單胞菌中汎耐藥株的檢齣率為0.17％(1/606),大腸埃希菌和肺炎剋雷伯菌中產超廣譜β-內酰胺酶菌株的檢齣率分彆為39.89(％(75/188)和29.23％(19/65),金黃色葡萄毬菌中耐甲氧西林(MRSA)的檢齣率為40.69％(271/666),凝固酶陰性葡萄毬菌中耐甲氧西林株的總檢齣率為52.38％ (22/42),腸毬菌中萬古黴素中介株的檢齣率為3.70％(2/54).MRSA的檢齣率呈上升趨勢(x2=18.317,P＜0.01).金黃色葡萄毬菌對替攷拉寧、萬古黴素和利奈唑胺均敏感;對利福平和阿米卡星的耐藥率(11.29％ ～ 33.33％)較低;對青黴素類和紅黴素的耐藥率(76.80％ ～ 100.00％)很高;對頭孢唑啉、頭孢呋辛、頭孢西丁、阿米卡星、左氧氟沙星的耐藥率呈上升趨勢(P＜0.05);對複方磺胺甲噁唑的耐藥率(28.11％ ～48.35％)呈下降趨勢(P＜0.01).銅綠假單胞菌對亞胺培南、美囉培南、複方磺胺甲噁唑的耐藥率呈上升趨勢(P＜0.05);對環丙沙星、左氧氟沙星、阿米卡星、慶大黴素、哌拉西林/他唑巴坦的耐藥率呈下降趨勢(P＜0.05);對頭孢哌酮/舒巴坦的耐藥率(9.15％～20.51％)最低.鮑曼不動桿菌對亞胺培南、美囉培南、左氧氟沙星、哌拉西林/他唑巴坦、複方磺胺甲噁唑的耐藥率均呈上升趨勢(P＜0.01);對頭孢哌酮/舒巴坦的耐藥率(11.86％ ～ 19.70％)最低.大腸埃希菌和陰溝腸桿菌對亞胺培南、美囉培南均敏感,對頭孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐藥率(0 ～ 14.29％)較低;大腸埃希菌對哌拉西林、頭孢吡肟、阿米卡星、左氧氟沙星、頭孢哌酮/舒巴坦的耐藥率均呈下降趨勢(P＜0.05);陰溝腸桿菌對頭孢西丁的耐藥率呈上升趨勢(P＜0.01),對哌拉西林、頭孢他啶、頭孢哌酮、頭孢麯鬆、左氧氟沙星的耐藥率均呈下降趨勢(P＜0.05).結論 2008至2012年河北醫科大學第三醫院骨科患者傷口感染病原菌以金黃色葡萄毬菌、銅綠假單胞菌、鮑曼不動桿菌、大腸埃希菌和陰溝腸桿菌為主,主要病原菌對常用抗菌藥物的耐藥性普遍較高.
목적 탐토골과환자상구병원균적분포급대항균약물적내약성변천.방법 련속수집2008년1월지2012년12월하북의과대학제삼의원골과주원환자상구분리적병원균자료,균주감정응용법국생물매리애공사Vitek 32감정계통,약민시험채용K-B법,채용선성추세,검험분석병원균분포급대항균약물적내약성변천.결과 5년간공분리출병원균2 456주,기중혁란음성간균1 652주(67.26％),혁란양성구균777주(31.64％),진균26주(1.06％),혁란양성간균l주(0.04％);거전5위적병원균의차시금황색포도구균(666주,27.12％)、동록가단포균(606주,24.67％)、포만불동간균(355주,14.45％)、대장애희균(188주,7.65％)화음구장간균(187주,7.61％).5년중,포만불동간균적검출솔정상승추세(x2=35.266,P＜0.01).포만불동간균중범내약주적검출솔위6.20％(22/355),동록가단포균중범내약주적검출솔위0.17％(1/606),대장애희균화폐염극뢰백균중산초엄보β-내선알매균주적검출솔분별위39.89(％(75/188)화29.23％(19/65),금황색포도구균중내갑양서림(MRSA)적검출솔위40.69％(271/666),응고매음성포도구균중내갑양서림주적총검출솔위52.38％ (22/42),장구균중만고매소중개주적검출솔위3.70％(2/54).MRSA적검출솔정상승추세(x2=18.317,P＜0.01).금황색포도구균대체고랍저、만고매소화리내서알균민감;대리복평화아미잡성적내약솔(11.29％ ～ 33.33％)교저;대청매소류화홍매소적내약솔(76.80％ ～ 100.00％)흔고;대두포서람、두포부신、두포서정、아미잡성、좌양불사성적내약솔정상승추세(P＜0.05);대복방광알갑오서적내약솔(28.11％ ～48.35％)정하강추세(P＜0.01).동록가단포균대아알배남、미라배남、복방광알갑오서적내약솔정상승추세(P＜0.05);대배병사성、좌양불사성、아미잡성、경대매소、고랍서림/타서파탄적내약솔정하강추세(P＜0.05);대두포고동/서파탄적내약솔(9.15％～20.51％)최저.포만불동간균대아알배남、미라배남、좌양불사성、고랍서림/타서파탄、복방광알갑오서적내약솔균정상승추세(P＜0.01);대두포고동/서파탄적내약솔(11.86％ ～ 19.70％)최저.대장애희균화음구장간균대아알배남、미라배남균민감,대두포고동/서파탄、고랍서림/타서파탄적내약솔(0 ～ 14.29％)교저;대장애희균대고랍서림、두포필우、아미잡성、좌양불사성、두포고동/서파탄적내약솔균정하강추세(P＜0.05);음구장간균대두포서정적내약솔정상승추세(P＜0.01),대고랍서림、두포타정、두포고동、두포곡송、좌양불사성적내약솔균정하강추세(P＜0.05).결론 2008지2012년하북의과대학제삼의원골과환자상구감염병원균이금황색포도구균、동록가단포균、포만불동간균、대장애희균화음구장간균위주,주요병원균대상용항균약물적내약성보편교고.
Objective To investigate the distribution and drug resistance of bacterial pathogens isolated from orthopedic wounds.Methods Data of bacterial strains isolated trom orthopedic wounds in the Third Hospital of Hebei Medical University from January 2008 to December 2012 were retrospectively analyzed.Strains were identified by using French bioMérieux Vitek32 identification system,and the drug susceptibility was tested by Kirby-Bauer method.Chi-square test for linear trend was performed to reveal the changes of distribution and drug resistance of the strains.Results A total of 2 456 bacterial strains were isolated,vith 1 652 (67.26％) gram-negative bacilli,777 (31.64％) gram-positive cocci,26 (1.06％) fungi,and 1 (0.04％) gram-positive bacillus.The top five pathogens were Staphylococcus aureus (666 strains,27.12％),Pseudomonas aeruginosa (606 strains,24.67％),Acinetobacter baumannii (355 strains,14.45％),Escherichia coli(188 strains,7.65％) and Enterobacter cloacae (187 strains,7.61％).The positive rate of Acinetobacter baumannii was on the rise during 2008 and 2012 (x2 =35.266,P ＜ 0.0l).The rates of pan-drug resistant strains in Acinetobacter baumannii and Pseudomonas aeruginosa were 6.20％ (22/355) and 0.17％ (1/606),respectively.The rates of extended-spectrum β-lactamases positive strains in Escherichia coli and Klebsiella pneumoniae were 39.89％ (75/188) and 29.23％ (19/65),respectively.The rates of methicillin-resistant strains in Staphylococcus aureus and coagulasenegative Staphylococcus were 40.69％ (271/666) and 52.38％ (22/42),respectively.The rate of vancomycin-intermediate strains in Enterococci was 3.70％ (2/54).The positive rate of methicillin-resistant &aphylococcus aureus was on the rise during 2008 and 2012 (x2 =18.317,P ＜ 0.01).Staphylococcus aureus were sensitive to teicoplanin,vancomycin and linezolid; Resistance rates to rifampicin and amikacin were 11.29％-33.33％; Resistance rates to penicillins and erythromycin were 76.80％-100.00％; Resistance rates to cefazolin,cefuroxime,cefoxitin,amikacin and levofloxacin were on the rise (P ＜ 0.05) ; And resistance rates to sulfamethoxazole (28.11％-48.35％) were on the decline in the same period (P ＜ 0.01).Resistance rates of Pseudomonas aeruginosa to imipenem,meropenem and sulfamethoxazole were on the rise (P ＜ 0.05) ; Resistance rates to ciprofloxacin,levofloxacin,amikacin,gentamicin and piperacillin/ tazobactam were on the decline (P ＜ 0.05) ; Resistance rates to cefoperazone/sulbactam were the lowest (9.15％-20.51％).Resistance rates of Acinetobacter baumannii to imipenem,meropenem,levofloxacin,piperacillin/tazobactam,sulfamethoxazole were on the rise (P ＜ 0.01); Resistance rates to cefoperazone/ sulbactam were the lowest (11.86％-19.70％).Escherichia coli and Enterobacter cloacae were sensitive to imipenem and meropenem,and the resistance rates to cefoperazone/sulbactam and piperacillin/tazobactam were low (0-14.29％); Resistance rates of Escherichia coli to piperacillin,cefepime,amikacin,levofloxacin,cefoperazone/sulbactam were on the decline (P ＜ 0.05) ; Resistance rates of Enterobacter cloacae to cefoxitin were on the rise (P ＜ 0.01),while the resistance rates to piperacillin,ceftazidime,cefoperazone,ceftriaxone,levofloxacin were on the decline (P ＜ 0.05).Conclusion During 2008 and 2012,the predominant bacterial pathogens of orthopedic wound in patients of the Third Hospital of Hebei Medical University are Staphylococcus aureus,Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli and Enterobacter cloacae,and most strains are multiple drug resistant.
