手部皮瓣移植患者术后感染的病原学分析与治疗  

Etiological analysis of postoperative infections in patients undergoing hand flap grafting and treatment

作　　者：李德胜 刘羽 刘国庆 林洪明 孙柒林 王谦 龚秋伟 

机构地区：[1]襄阳市第一人民医院手外科,湖北襄阳441000

出　　处：《中华医院感染学杂志》2014年第14期3579-3581,共3页Chinese Journal of Nosocomiology

基　　金：襄阳市卫生局基金资助项目(HX-2010A-046)

摘　　要：目的探讨手部皮瓣移植患者术后感染的病原学分析及治疗措施,以期提高临床治疗水平。方法回顾性分析2010年3月-2013年3月110例手部皮瓣移植术后感染患者,按照感染程度的不同分为轻中度和重度感染两组,分别对其进行病原菌分析,并对主要病原菌采用K-B纸片扩散法进行耐药性分析;采用PPMS软件进行统计分析。结果手部皮瓣移植轻中度感染患者检出病原菌62株,其中以酿脓链球菌、金黄色葡萄球菌、大肠埃希菌、浅绿气球菌为主,分别占27.42%、24.19%、20.97%、14.52%;手部皮瓣移植重度感染患者检出病原菌59株,其中以粪肠球菌、凝固酶阴性葡萄球菌、铜绿假单胞菌为主,分别占35.59%、28.81%、22.03%;轻中度感染革兰阳性菌对青霉素耐药率最高,均〉88.89%,对美罗培南和亚胺培南耐药率最低均为0;重度感染革兰阳性菌对替考拉宁、头孢米诺、头孢噻肟耐药率较低为0-7.69%,对其他抗菌药物的耐药率均在15.38%-90.47%。结论在治疗手部皮瓣移植患者术后不同程度感染时要结合病原菌合理选择抗菌药物进行治疗。OBJECTIVE To explore the etiological characteristics of postoperative infections in the patients undergoing hand flap grafting and put forward the treatment measures so as to improve the level of clinical treatment.METHODS A total of 110patients with postoperative infections who underwent the hand flap grafting from Mar2010to Mar 2013were retrospectively reviewed and divided into the mild and moderate infection group and the severe infection group according to the severity of infections,then the distribution of pathogens was analyzed,the drug resistance of the major species of pathogens was analyzed by using the K-B disk diffusion method,and the statistical analysis was performed with the use of PPMS software.RESULTS Totally 62strains of common pathogens have been isolated from the patients with mild and moderate infections,among which Streptococcus pyogenes,Staphylococcus aureus,Escherichia coli,and Aerococcus viridans were the predominant species,accounting for27.42%,24.19%,20.97%,and 14.52%,respectively.Totally 59strains of common pathogens have been isolated from the patients with severe infections,among which the Enterococcus faecalis,coagulase-negative Staphylococci,and Pseudomonas aeruginosa were dominant,accounting for 35.59%,28.81%,and 22.03%,respectively.The drug resistant rate of the gram-positive bacteria causing the mild and moderate infections to penicillin was the highest（more than 88.89%）,and the drug resistance rates to meropenem and imipenem were the lowest（0）;the drug resistance rates of the gram-positive bacteria causing severe infections to teicoplanin,cefminox,and cefotaxime were low,ranging from 0to 7.69%,and the drug resistance rates to other antibiotics varied from15.38%to 90.47%.CONCLUSIONFor the treatment of different severities of postoperative infections in the patients undergoing hand flap grafting,it is necessary to reasonably use antibiotics based on the result of drug susceptibility testing.

关 键 词：手部皮瓣移植术后 感染 病原菌 耐药性 临床诊治 

分 类 号：R619.3[医药卫生—外科学]