开放性骨折伤口感染病原菌分布及耐药率监测  

Pathogen distribution and drug resistance detection of wound infection of open fracture

作　　者：崔庆[1] 崔浩然[2] 喻东梅[1] 刘青[1] 

机构地区：[1]解放军第88医院检验科,山东泰安271000 [2]山东大学07级生命科学院,济南250000

出　　处：《中国矫形外科杂志》2010年第13期1091-1093,共3页Orthopedic Journal of China

摘　　要：[目的]调查开放性骨折伤口感染患者的病原菌分布及耐药趋势,为临床抗菌药物的使用提出合理建议。[方法]对2004年1月～2008年12月本院骨科住院开放性骨折患者各类标本共136例,采用ATB Expression自动细菌鉴定及药敏实验。[结果]136例开放性骨折伤口感染标本中,共分离到细菌151株,金黄色葡萄球菌、铜绿假单胞菌、溶血葡萄球菌、表皮葡萄球菌、大肠埃希菌检出率最高,分别为17.22%、13.24%、11.92%、9.93%、9.27%;MRSA占>57.70%,革兰阳性球菌占48.34%,革兰阴性杆菌占43.05%,假丝酵母菌属占8.61%。大肠埃希菌中产超广谱β-内酰胺酶(ESBLs)株占28.6%,革兰阴性杆菌除头孢哌酮/舒巴坦未发生耐药外,对氨苄西林、氨苄西林/舒巴坦、头孢唑啉耐药率高达71.4%。葡萄球菌属对甲氧西林的耐药率>57.7%,除万古霉素未发生耐药外,较敏感的抗菌药物有复方新诺明、呋喃妥因、利福平、四环素。[结论]内源性的正常菌群或来自周围环境中的条件致病菌已成为开放性骨折伤口感染的主要致病菌,因此,早期积极采取正确及时的清创处理及合理使用抗菌药物等,对于预防骨折术后感染有着积极的作用。[ Objective ] To study the bacteriological feature of the wound infection of open fracture and supply the reasonable advise to the use of antibacterials. [ Methods] One hundred and thirty -six samples were collected from the wound patients with open fracture between January in 2004 and December in 2008. The identification of bacteria and drug sensitive test were carded out by ATP - expression. [ Results ] One hundred and fifty one isolates were collected from 136 samples. The prevalence of staphylococcus aureus, pseudomonas aeruginosa, staphylococcus haemolyticus, staphylococcus epidermidis, colon bacillus were most , accounting for 17. 22% , 13.24% , 11.92% , 9. 93% and 9. 27% respectively. The prevalence of MRSA was higher than 57.7%. Gram positive coccus , gram negative bacilli and candida accounted for 48. 34%, 43.05% and 8.61% respectively. The prevalence of ESBLs was 28. 6%. None of gram negative bacilli was found resistant to sulbactam and cefopcrazone. The resistance rate of gram negative bacilli to ampicillin , ampicillin - sulbactam and cephazolme were 71.4%. The rate of resistance of staphylococcus to methicillin was higher than 57.7%. Except vancomycin was not drug -fast, some sensitive antibacterials include cotrimoxazole, ni^rofurantion, rifampicm tetracycline. [ Conclusion ] Endogenic normal flora and conditioned pathogen from the surroundings have become the main pathogens of the wound infection of open fracture. So the early debride and reasonable use of antibacterials would play a positive role in preventing postoperative fracture infection.

关 键 词：开放性骨折 伤口感染 病原菌分布 耐药率监测 

分 类 号：R446.5[医药卫生—诊断学]