烧伤住院患者感染病原菌的分布及耐药性分析

发布时间：2018-04-29 15:56

本文选题：烧伤 + 细菌感染　；参考：《上海交通大学学报(医学版)》2017年04期

【摘要】：目的·分析烧伤病房的病原菌菌种分布及耐药性的变化,为临床合理应用抗菌药物、减少耐药株产生及医院感染控制提供依据。方法·收集2011年1月—2014年12月烧伤病房送检标本的分离菌株,对感染来源、菌种分布及主要致病菌耐药率前后2年的变化趋势进行统计学分析。结果·共检出病原菌2 399株,革兰阴性杆菌(G-b)1 286株(53.61%),革兰阳性球菌(G+c)1 088株(45.35%),真菌25株(1.04%)。G-b常见为铜绿假单胞菌(447株,34.76%)和鲍曼不动杆菌(369株,28.69%),G+c最常见为金黄色葡萄球菌(489株,44.94%),真菌常见为白念珠菌(8株,33.33%)。后2年与前2年比较,金黄色葡萄球菌和鲍曼不动杆菌的检出率明显下降,铜绿假单胞菌检出率明显上升(P0.05);铜绿假单胞菌和鲍曼不动杆菌对第3、4代头孢类、碳青霉烯类、氨基糖苷类和喹诺酮类抗菌药物耐药率较高(80%),其变化无统计学意义(P0.05);金黄色葡萄球菌仅对青霉素高度耐药(97.58%),对万古霉素100%敏感,对头孢唑啉、氨苄西林/舒巴坦、庆大霉素、左氧氟沙星和利福平的耐药率明显降低(P0.05),耐甲氧西林金黄色葡萄球菌(MRSA)检出率由72.28%降至63.00%(P0.05)。结论·烧伤病房检出多种院内感染病原菌,且耐药问题严重;改善管理并合理应用抗菌药物可减缓耐药菌发生,提高临床抗感染治疗和院内感染的控制效果。
[Abstract]:Objective to analyze the distribution of pathogenic bacteria and the change of drug resistance in burn ward so as to provide evidence for rational application of antimicrobial agents and reduction of drug resistant strains and control of nosocomial infection. Methods isolated strains were collected from burn ward from January 2011 to December 2014. The source of infection, the distribution of bacteria and the change trend of drug resistance rate of main pathogenic bacteria were analyzed statistically. Results A total of 2 399 strains of pathogenic bacteria were detected. Gram-negative bacilli (G-BN 1 286) and Acinetobacter baumannii (28.699.69 Gc) were the most common, Gram-positive cocci 1 088 strains (45.3535), fungi 25 strains (1.04%). G-b (25 strains) were Pseudomonas aeruginosa (447 strains) and Acinetobacter baumannii (369 strain 28.6969 Gc) were the most common strains: Staphylococcus aureus (489), Staphylococcus aureus (44.9433.33), fungi (Candida albicans 8 strains). The detection rate of Staphylococcus aureus and Acinetobacter baumannii decreased significantly in the last two years, and the positive rate of Pseudomonas aeruginosa increased significantly (P0.05A), while the detection rate of Pseudomonas aeruginosa and Acinetobacter baumannii was significantly higher than that in the first two years. The antimicrobial resistance of aminoglycosides and quinolones was higher than that of aminoglycosides and quinolones, but there was no significant difference between them (P 0.05), Staphylococcus aureus was only highly resistant to penicillin, sensitive to vancomycin, 100% to vancomycin, to cefazolin, ampicillin / sulbactam, gentamicin, and gentamicin. The drug resistance rate of levofloxacin and rifampicin decreased significantly, and the detection rate of methicillin-resistant staphylococcus aureus decreased from 72.28% to 63.00%. Conclusion A variety of nosocomial infection pathogens were detected in burn ward, and the problem of drug resistance was serious, and the improvement of management and rational application of antimicrobial agents could slow down the occurrence of drug-resistant bacteria and improve the control effect of clinical anti-infection therapy and nosocomial infection.
【作者单位】：上海交通大学医学院附属瑞金医院烧伤整形科;上海交通大学医学院附属瑞金医院临床微生物科;
【分类号】：R644;R446.5

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