骨折内固定术后迟发感染的细菌耐药性检测  

Bacteriological analysis and drug-resistences tests in chronic infected patients with post-internal fixation of fructure

作　　者：武湘云[1] 冯和林[2] 黄印启[1] 李增炎[2] 潘进社[2] 

机构地区：[1]河北医科大学第三医院检验科,石家庄050051 [2]河北医科大学第三医院骨科,石家庄050051

出　　处：《中国综合临床》2008年第2期131-132,共2页Clinical Medicine of China

基　　金：河北省科技厅资助项目（06276102D-90）

摘　　要：目的研究骨折内固定术后迟发感染的细菌耐药性，指导临床正确应用抗生素。方法对66例骨科迟发感染患者的分泌物或脓液进行细菌培养及药敏实验，寻找骨科迟发感染的细菌与抗生素之间的关系。结果66例术后患者分离出病原菌51株，细菌检出率77．3％。细菌鉴定及药敏试验：在分离出的病原菌中以革兰阴性杆菌居多，占62．7％，对亚胺培南耐药性最低，其次对头孢三代较为敏感；革兰阳性球菌占37．3％。对万古霉素、替考拉宁敏感率100％。15例患者分泌物中未分离出病原菌，占22．7％。结论骨科迟发感染的病原菌中，革兰阴性杆菌占大多数，革兰阳性球菌感染发生率少于革兰阴性杆菌。临床预防性使用抗生素，革兰阳性球菌可以选用替考拉宁和利福平等，革兰阴性杆菌可以选用亚胺培南、喹诺酮类等。Objective To investigate the characteristics of bacterial drug-resistence of post-internal fixation of fructure and to direct the use of antibiotics in clinics. Method： Secretion and liquor puris bacteriology was conducted among 66 patients with chronic infected wounds to find the relation between familiar infetion bacterias and antibiotics. Results Altogether 51 strains were isolated. Positive cases took account of 77.3% in total. The main pathogens found were Gramnegative bacilli with the rate of 62.7%, while their drug-reslstance to imipenem was the lowest. They also showed lower resistance to the 3rd generation of cephalosporins compared with any other antibiotics. Grampositivecocci were found in 37.3% cases,which were completely sensitive to Vancomycin and Teicoplanin. No strains were isolated during the examination of wounds of 15 patients （22.7% ）. Conclusion Of all post-operative infection bacterias in orthopaedics clinics, the majority is Gramnegative germs, and Grampositive germs infections are less than the former,in which the primacy is staphylococcus aureus. In terms of preventative post-operation antibiotics of orthopaedics,Teicoplanin and Rifampicin are preferred drugs against Grampositive germs. For the Gramnegative germs,the preferable one is imipenem and quinolones.

关 键 词：骨折 迟发感染 耐药性 抗生素 

分 类 号：R446.5[医药卫生—诊断学]