• 感染性慢性难愈合创面病原菌分布特点及耐药性分析
  • Analysis on the Distribution Characteristics and Drug Resistance of Pathogenic Bacteria in Infectious Chronic Refractory Wounds
  • 陈兴阳,陈 雷,吉希杰.感染性慢性难愈合创面病原菌分布特点及耐药性分析[J].中国烧伤创疡杂志,2021,(2):86~90.
    DOI:
    中文关键词:  慢性难愈合创面  感染  病原菌  耐药性  多重耐药
    英文关键词:Chronic refractory wound  Infection  Pathogenic bacteria  Drug resistance  Multi-drug resistance
    基金项目:
    作者单位
    陈兴阳 常州市德安医院外科 
    陈 雷  
    吉希杰  
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    中文摘要:
          目的 分析探讨感染性慢性难愈合创面的病原菌分布特点及其耐药性。方法 回顾性总结2016年1月至2018年12月常州市德安医院收治的84例合并感染的慢性难愈合创面患者的病历资料,分析其病原菌分布特点以及主要革兰氏阳性菌、革兰氏阴性菌对抗菌药物的耐药情况。结果 84例患者共采集标本143份,其中病原菌阳性标本108份(75.52%),共分离培养出病原菌126株,其中革兰氏阴性菌71株(56.35%)、革兰氏阳性菌52株(41.27%)、真菌3株(2.38%);主要革兰氏阴性菌铜绿假单胞菌对替卡西林、复方新诺明具有较高耐药性,大肠埃希菌、奇异变形杆菌均对阿莫西林、哌拉西林、头孢西丁、美罗培南、亚胺培南、阿米卡星具有较高敏感性,鲍曼不动杆菌对抗菌药物均具有较高耐药性,粘质沙雷菌对大部分抗菌药物具有较高敏感性;主要革兰氏阳性菌金黄色葡萄球菌对除红霉素外的大部分抗菌药物具有较高敏感性,而粪肠球菌对大部分抗菌药物具有较高耐药性;126株病原菌中共有31株(24.60%)病原菌出现多重耐药,以金黄色葡萄球菌(35.48%)、大肠埃希菌(29.03%)、鲍曼不动杆菌(19.35%)为主,在同期本院同种耐药菌中占比较高。结论 感染性慢性难愈合创面的病原菌分布具有多样性、复杂性等特点,临床治疗中前期应根据慢性难愈合创面以金黄色葡萄球菌和铜绿假单胞菌感染为主的特点、后期应根据病原菌培养结果选用敏感抗菌药物进行抗感染治疗,以减少耐药菌产生,提高治疗效果,降低医疗费用。
    英文摘要:
          【Abstract】Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in infectious chronic refractory wounds. Methods: The medical data of 84 patients with chronic refractory wounds combined with infection admitted into De’an Hospital of Changzhou City between January 2016 and December 2018 were summarized retrospectively to analyze the distribution characteristics of pathogenic bacteria and drug resistance of major gram-positive and gram-negative bacteria to antibacterial agents. Results: A total of 143 samples were collected from the 84 patients,of which 108 samples (75.52%) were pathogenic bacteria positive. From the 108 positive samples,126 strains of pathogenic bacteria were separated,of which 71 strains (56.35%) were gram negative bacteria,52 strains (41.27%) were gram positive bacteria and 3 strains (2.38%) were fungi. Of the major gram negative bacteria,Pseudomonas aeruginosa showed a high drug resistance to Ticarcillin and Compound Sulfamethoxazole,Escherichia coli and Proteus mirabilis presented a high sensitivity to Amoxicillin,Piperacillin,Cefoxitin,Meropenem,Imipenem and Amikacin,Acinetobacter baumannii showed a high drug resistance to all antibacterial agents,and Serratia marcescens had a high sensitivity to majority of antibacterial agents. Of the major gram positive bacteria,Staphylococcus aureus showed a much high sensitivity to most bacterial agents except Erythrocin,and Enterococcus faecalis had a high drug resistance to a majority of antibacterial agents. Of the 125 strains of pathogenic bacteria,31 strains (24.60%) presented multi-drug resistance,especially in Staphylococcus aureus (35.48%),Escherichia coli (29.03%) and Acinetobacter baumannii (19.35%),accounting for a higher proportion of the drug-resistant bacteria of the same species during the same period in the hospital. Conclusion: The distribution of pathogenic bacteria in infectious chronic refractory wounds has the characteristics of diversity and complexity. During the early and middle stage of clinical treatment the wounds were mainly infected by Staphylococcus aureus and Pseudomonas aeruginosa,and at the late stage of treatment,sensitive antibacterial agents should be selected to combat infection based on the bacterial culture results to reduce the occurrence of drug resistance,improve curative effect,and cut down the medical cost.