587例手外伤感染患者伤口致病菌分布及对抗生素敏感性分析  

Analysis of pathogen distribution and antibiotic susceptibility in infected wounds of hand trauma from 587 patients

作　　者：刘颖[1] 张会英[1] 吴俊[1] 朱伟[2] 王艳[1] 孟昭阳[1] 李凤敏[1] 童静[1] 

机构地区：[1]北京积水潭医院检验科,100035 [2]北京积水潭医院手外科,100035

出　　处：《中华手外科杂志》2014年第2期131-134,共4页Chinese Journal of Hand Surgery

摘　　要：目的监测手外伤感染患者伤口致病菌的分布及对抗生素的敏感性，为临床经验性应用抗生素提供依据。方法细菌鉴定采用表型鉴定，药物敏感试验采用抗生素最低抑菌浓度（minimuminhibitoryconcentration，MIC）微量稀释法和／或纸片法。结果587例患者伤口共分离出98种603株细菌，前十位细菌占64．18％。需氧兼性厌氧革兰阳性球菌占38．97％，需氧兼性厌氧革兰阴性杆菌占57．21％，厌氧菌占3．48％。在金黄色葡萄球菌和表皮葡萄球菌中耐甲氧西林的菌株分别占19．12％和73．77％；未检出对万古霉素、利奈唑胺耐药的金黄色葡萄球菌和表皮葡萄球菌，耐甲氧西林金黄色葡萄球菌（MRSA）敏感率大于90％的抗生素为复方新诺明。耐甲氧西林表皮葡萄球菌（MRsE）敏感率大于90％的抗生素为利福平。未检出耐万古霉素的粪肠球菌；耐万古霉素屎肠球菌检出率为11．76％，粪肠球菌对抗生素的敏感率都高于屎肠球菌。未检出多重耐药的铜绿假单胞菌，铜绿假单胞菌敏感率均大于80％。鲍曼醋酸钙复合不动杆菌多重耐药发生率为27．27％，敏感率在9．09％．56．52％范围内，亚胺培南最敏感。产超广谱口内酰胺酶（ESBL）大肠埃希菌检出率为58．06％，ESBL肺炎克雷伯菌的检出率为36．36％。阴沟肠杆菌敏感率大于80％的为阿米卡星、头孢吡肟、左氧沙星、哌拉西林／他唑巴坦。未检出耐亚胺培南、美罗培南的大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌和产酸克雷伯菌。结论虽然手外伤感染细菌种类繁多，但相对集中于前十种菌；未检出耐万古霉素、利奈唑胺金黄色葡萄球菌和表皮葡萄球菌；粪肠球菌对抗生素的敏感性高于屎肠球菌；铜绿假单胞菌对抗生素的敏感性高；不动杆菌对抗生素敏感率非常低；未检出耐亚胺培南、美罗培南的大肠埃希菌、肺炎克雷伯菌�Objective To monitor the distribution and drug susceptibility of bacteria in infected wound from patients with hand injuries and provide evidence for selection of antibiotics. Methods Bacteria in the wound were identified by phenotype identification. Micro-dilution or/and Kirby-Bauer methods were adopted to measure the minimum inhibitory concentration of the antibiotics for drug susceptibility test. lults A total of 603 strains of 98 species of bacteria were isolated from wounds of 587 patients. Strains in top 10 species of pathogens accounted for 64.18 %. Aerobic/facultative anaerobic gram-positive bacteria accounted for 38.97 %. Aerobic/factdtative anaerobic gram-negative bacteria accounted for 57.21%. Anaerobic bacteria accounted for 3.48%. There were 19.12% of Methicillin-resistant strains among S. aureus （MRSA） and 73.77% of those among S. epidermidis （MRSE）. No Vancomycin （VA）-resistant and Linezolid （LZD） -resistant strains were found among MRSA and MRSE. SMZ-co had 〉 90% susceptible rates among MRSA. Rifampin had 〉 90% susceptible rates among MRSE. No VA-resistant strains were identified among E. faecalis, while there were 11.76% of VA-resistant strains among E. faecium. E. faecalis had higher sensitivity to all antibiotics than E. faecium. All antibiotics used had 〉 80% susceptible rates among P. aeruginosa without Multi-Drug Resistant strains （MDR）. Susceptible rates of antibiotics used are between 9.09% and 56.52% and lmipenem （IPM） bad the highest susceptible rates among A. baumanii/calcoaceticus complex with 27.27% of MDR. There were 58.06% and 36.36% of ESBl_s-producing strains among E. coli and K. pneumoniae, respectively. Amikacin （AK）, Cefepime, Levofloxacin and Piperacillin-tazobactam （TZP） were 〉 80% in susceptible rates among E. cloacae. No test for IPM-resistant or Meropenem （MEM）-resistant strains among E. coli, K. pneumoniae and E. cloacae and K. oxytoca was positive. Conclusion There are a variety of bacteria in hand injury wounds. They are mainl

关 键 词：感染 细菌 抗生素 手外伤 

分 类 号：R446.5[医药卫生—诊断学]