新鲜开放性骨折感染前后创面细菌学及药敏性的研究

发布时间：2018-10-05 16:31

【摘要】：目的探讨新鲜开放性骨折(open fracture)患者感染前后创面细菌种类及其药敏试验(Antimicrobial susceptibility test,AST)情况,以期指导临床抗生素的使用。方法42例于2015年5月至2016年8月我院收治的新鲜开放性骨折并后续发生感染的患者,统计其入院急诊清创术中,以及感染发生后分别进行创面细菌培养及药敏试验情况,并对结果进行分析。结果急诊清创术中创面细菌培养阳性者4例,共培养出4例病原菌,均为阴沟肠杆菌(Enterobacter cloacae)及大肠埃希菌(Escherichia coli,E.coli),且同感染后培养出相同的病原菌者仅1例;感染发生后细菌培养阳性者40例,共培养出48株病原菌,主要为铜绿假单胞菌(P.Aeruginosa)14株,大肠埃希菌12株,鲍曼不动杆菌(Acinetobacter baumannii,Ab)4株,肺炎克雷伯菌(Klebsiella Pneumoniae,Kpn)4株,阴沟肠杆菌2株,表皮葡萄球菌(Staphylococcus epidermidis)6株,金黄色葡萄球菌(Staphylococcus aureus)6株,多为革兰阴性菌(75%,36/48);头孢哌酮、左氧氟沙星对于各主要病原菌敏感性较高,耐药率均35%;共培养出6株多重耐药菌(multiple resistant bacteria,MDR),对临床常用抗菌药普遍耐药。结论无法根据急诊清创术中细菌培养情况推测引起后续感染的致病菌,开放性骨折感染多由革兰阴性菌所致。MDR占有不小比例,需严格控制院内感染,临床治疗上需根据感染后细菌培养结果调整抗生素使用,才能更好地预防和控制感染。
[Abstract]:Objective to investigate the bacterial species and drug sensitivity test (Antimicrobial susceptibility test,AST) in patients with fresh open fracture (open fracture) before and after infection, in order to guide the clinical use of antibiotics. Methods from May 2015 to August 2016, 42 patients with fresh open fracture and subsequent infection were collected, and the bacterial culture and drug sensitivity test were performed in the patients who were admitted to the hospital for emergency debridement, as well as after the infection. The results were analyzed. Results in emergency debridement, 4 cases were positive for bacteria culture, 4 cases were Enterobacter cloacae (Enterobacter cloacae) and Escherichia coli (Escherichia coli,E.coli), and only 1 case had the same bacteria after infection. After infection, 48 strains of pathogenic bacteria were cultured, including 14 strains of Pseudomonas aeruginosa (P.Aeruginosa), 12 strains of Escherichia coli, 4 strains of Acinetobacter baumannii (Acinetobacter baumannii,Ab), 4 strains of Klebsiella pneumoniae (Klebsiella Pneumoniae,Kpn) and 2 strains of Enterobacter cloacae. Six strains of Staphylococcus epidermidis (Staphylococcus epidermidis) and six strains of Staphylococcus aureus (Staphylococcus aureus) were Gram-negative bacteria (75 / 36 / 48), and cefoperazone and levofloxacin were highly sensitive to major pathogens. 6 strains of multidrug resistant bacteria (multiple resistant bacteria,MDR) were cultured, and they were generally resistant to antibiotics commonly used in clinic. Conclusion it is impossible to speculate the bacteria that cause subsequent infection according to the condition of bacterial culture in emergency debridement. The infection of open fracture is caused by Gram-negative bacteria in large proportion, so it is necessary to strictly control the nosocomial infection. In order to prevent and control infection, we should adjust the use of antibiotics according to the results of bacterial culture after infection.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R683

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