开放性骨折患者术后伤口感染的细菌学特点及对抗菌药物的耐药性分析

发布时间：2018-03-13 07:28

本文选题：开放性骨折　切入点：伤口感染　出处：《中华医院感染学杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的调查分析开放性骨折患者术后伤口感染的细菌学特点及对抗菌药物的耐药性,为临床诊疗提供参考依据。方法选取2014年5月-2016年7月医院骨科收治的开放性骨折术后伤口感染患者232例,采集患者开放性骨折伤口的分泌物进行培养与鉴定,对其伤口感染情况进行调查,并对获得的菌株进行药敏试验,分析感染患者的细菌学特点及耐药情况,并进行统计分析。结果 232例患者中,211例患者细菌培养呈阳性,细菌检出率为90.9%;所有标本共分离出病原菌296株,革兰阴性菌,占61.8%;革兰阳性菌,占33.4%;真菌,占4.7%;伤口感染检出率最高3种病原菌依次为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌,分别占18.6%、17.2%、15.2%;对主要病原菌进行药敏试验,耐药率最高的药物为青霉素,耐药率均在75%以上,而耐药率最低的药物为万古霉素菌株,耐药率均低于2%,其次为亚安培南。结论开放性骨折患者术后伤口感染的病原菌主要以革兰阴性菌为主,其中检出率最高的病原菌分别为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、表皮葡萄球菌、肺炎克雷伯菌及鲍氏不动杆菌,且各种病原菌对多种常见抗菌药物耐药率较高,其中耐药率最高的为青霉素,耐药率最低的为万古霉素,因此,临床医护人员应根据伤口病原菌培养情况及药敏结果进行合理用药方案的制定,以有效控制感染。
[Abstract]:Objective to investigate the bacteriological characteristics of wound infection in patients with open fracture after operation and its resistance to antimicrobial agents. Methods from May 2014 to July 2016, 232 patients with wound infection after open fracture operation were selected, and the secretion of open fracture wound was collected for culture and identification. The bacterial characteristics and drug resistance of the infected patients were analyzed and statistically analyzed. Results among 232 patients, 211 patients were positive for bacterial culture. The detection rate of bacteria was 90.9. 296 strains of pathogenic bacteria were isolated from all specimens, with Gram-negative bacteria accounting for 61.8%; Gram-positive bacteria with 33.4%; fungi with 4.7%; the highest detection rates of wound infection were Escherichia coli and Staphylococcus aureus. Pseudomonas aeruginosa, accounting for 18.6X / 17.2g / 15.2.The drug resistance rate of the main pathogenic bacteria was penicillin, the drug resistance rate was above 75%, and the lowest drug resistance rate was vancomycin strain. Conclusion Gram-negative bacteria are the main pathogens of wound infection in patients with open fracture, and the highest detection rates are Escherichia coli and Staphylococcus aureus, respectively. Pseudomonas aeruginosa, Staphylococcus epidermidis, Klebsiella pneumoniae and Acinetobacter baumannii have higher resistance to a variety of common antibiotics, among which penicillin is the highest and vancomycin is the lowest. In order to control infection effectively, medical staff should make rational drug use plan according to the condition of wound pathogen culture and the result of drug sensitivity.
【作者单位】：浙江省义乌市中心医院骨科;
【基金】：国家自然科学基金资助项目(81000812)
【分类号】：R687.3

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