66例内植物相关性慢性骨髓炎菌群特点及耐药性分析

发布时间：2019-01-06 19:54

【摘要】：目的:统计分析我科66例内植物相关性慢性骨髓炎患者的菌群特点及耐药情况,为临床治疗骨髓炎提供依据。方法:统计分析我科2012年3月至2014年12月收治的66例内植物相关性慢性骨髓炎的细菌培养及药物敏感试验的数据。(1)66例患者中女性13例,男性53例,患者年龄最小12岁,最大68岁,平均41岁。按部位划分:髋关节5例,股骨24例,胫骨28例,腓骨2例,踝关节4例,跟骨1例,肱骨1例,尺骨1例。(2)17例患者术前无菌下取窦道分泌物留作标本,所有患者初次手术清创前至少停用抗生素1周,术中均留取不同位置的6份标本(死骨、内固定物、脓液、深层坏死组织、骨髓内、坏死与正常骨交界处)。结果:1、66例慢性骨髓炎患者术中培养出21种96株病原菌,3例患者培养出3种,24例培养出2种,39例培养出1种细菌。培养出57株革兰氏阳性菌,占59.38%;38株革兰氏阴性菌,占39.58%,1例真菌(光滑念珠菌),占1.04%。金黄色葡萄球菌检出31株,占32.29%,比例最高,其余依次为:铜绿假单胞菌(11.46%)、耐甲氧西林金黄色葡萄球菌(MRSA)(9.38%)、表皮葡萄球菌(9.38%)、大肠埃希菌(8.33%)。2、多重耐药菌分离出34例,占35.42%,前四位是:金黄色葡萄球菌(26.47%),表皮葡萄球菌(26.47%),大肠埃希菌(14.71%),铜绿假单胞菌(8.82%)。革兰氏阳性菌对万古霉素和利奈唑烷的耐药率最低,青霉素最高。MRSA对绝大多数抗生素耐药,未发现耐万古霉素的MRSA。革兰氏阴性菌对亚胺培南类耐药性最低,氨苄西林类最高。铜绿假单胞菌对阿米卡星、美罗培南及喹诺酮类药物耐药率均为8.33%,对大多数头孢类高度耐药。3、17例患者术前及术中培养细菌比较,其中不一致的8例,占47.06%。结论:1、在内植物相关性慢性骨髓炎患者中,革兰氏阳性菌所占比重高于革兰氏阴性菌。2、多重耐药菌比例近1/3。3、规范留取标本,可提高培养致病菌的准确率。
[Abstract]:Objective: to analyze the bacteriological characteristics and drug resistance of 66 patients with phyto-associated chronic osteomyelitis in order to provide evidence for clinical treatment of osteomyelitis. Methods: from March 2012 to December 2014, the data of bacterial culture and drug sensitivity test in 66 patients with phyto-associated chronic osteomyelitis were analyzed. (1) 13 cases were female, 53 cases were male, the age of the patients was 12 years old. The oldest was 68 years old, with an average of 41 years old. There were 5 cases of hip joint, 24 cases of femur, 28 cases of tibia, 2 cases of fibula, 4 cases of ankle, 1 case of calcaneus, 1 case of humerus and 1 case of ulna. All patients stopped antibiotics for at least one week before debridement, and 6 specimens (dead bone, internal fixator, pus, deep necrotic tissue, bone marrow, junction between necrosis and normal bone) were taken during operation. Results: (1) in 66 patients with chronic osteomyelitis, 21 strains of 96 pathogens were cultured, 3 strains were cultured in 3 cases, 2 strains were cultured in 24 cases, and 1 strain was cultured in 39 cases. 57 Gram-positive strains were cultured, 38 Gram-negative strains were found in 59.38 strains, and 1 case of fungi (Candida smoothing) was found in 39.58 cases, accounting for 1.04%. 31 strains of Staphylococcus aureus (32.29%) were detected, and the rest were Pseudomonas aeruginosa (11.46%), methicillin-resistant Staphylococcus aureus (MRSA) (9.38%), Staphylococcus epidermidis (9.38%), Staphylococcus epidermidis (9.38%). Escherichia coli (8.33%). 34 cases (35.422%) of multidrug resistant bacteria were isolated. The first four were Staphylococcus aureus (26.47%), Staphylococcus epidermidis (26.47%), Escherichia coli (14.71%), Staphylococcus aureus (26.47%), Staphylococcus epidermidis (26.47%). Pseudomonas aeruginosa (8.82%). Gram-positive bacteria had the lowest resistance to vancomycin and linazolane, and penicillin was the highest. MRSA was resistant to most antibiotics, but no vancomycin resistant MRSA. was found. Gram-negative bacteria had the lowest resistance to imipenem, and ampicillin was the highest. The resistance rates of Pseudomonas aeruginosa to amikacin, meropenem and quinolones were 8.33, and highly resistant to most cephalosporins. Conclusion: 1. In patients with chronic osteomyelitis associated with plants, the proportion of Gram-positive bacteria is higher than that of Gram-negative bacteria.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R681.2

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