骨科伤口标本分离革兰阴性杆菌及其耐药性  

Distribution and antimicrobial resistance of gram-negative bacilli isolated from wound specimens of orthopedic patients

作　　者：王艳[1] 张会英[1] 吴俊[1] 刘颖[1] 陈慧毅[1] 

机构地区：[1]北京积水潭医院,北京100035

出　　处：《中国感染控制杂志》2016年第2期102-105,共4页Chinese Journal of Infection Control

基　　金：吴阶平医学基金会临床科研专项资助(320.6750.10078)

摘　　要：目的了解骨科伤口标本分离革兰阴性（G^-）杆菌的分布及其耐药性,为临床合理使用抗菌药物提供依据。方法收集2011年1月—2013年12月某综合性医院骨科各病区分离的682株G-杆菌,进行药敏结果分析。结果骨科伤口标本的G^-杆菌主要是铜绿假单胞菌（16.72%）、大肠埃希菌（15.40%）和阴沟肠杆菌（12.76%）。产超广谱β-内酰胺酶（ESBLs）大肠埃希菌和肺炎克雷伯菌检出率分别为54.29%（57/105）和31.43%（22/70）,两种细菌均主要分布在创伤骨科,分别占49.12%和45.45%。大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌对美罗培南和亚胺培南的敏感率均为100%。大肠埃希菌和肺炎克雷伯菌对阿米卡星、哌拉西林/他唑巴坦、阿莫西林/克拉维酸的敏感率均〉80%。除对哌拉西林的敏感率为64.37%外,阴沟肠杆菌对大部分抗菌药物敏感率介于71.26%～100.00%。铜绿假单胞菌除对头孢吡肟和氨曲南的敏感率为78.95%和65.79%外,对其他抗菌药物的敏感率均〉85%。结论 G^-杆菌是骨科伤口感染的重要病原菌,了解其菌种分布及耐药性,有利于合理使用抗菌药物,提高临床治疗效果。Objective To investigate the distribution and antimicrobial resistance of gram-negative bacilli isolated from wound specimens of orthopedic patients,and provide reference for the rational use of antimicrobial agents.Methods 682 isolates of gram-negative bacilli were collected from orthopedic department in a comprehensive hospital between January 2011 and December 2013,antimicrobial susceptibility testing results were analyzed.Results The main gram-negative bacilli isolated from wound specimens of orthopedic patients were Pseudomonas aeruginosa（P.aeruginosa）（16.72%）,Escherichia coli（E.coli）（15.40%）,and Enterobacter cloacae（E.cloacae）（12.76%）.The detection rates of extended-spectrum beta-lactamase- producing E.coli and Klebsialla pneumoniae（K.pneumoniae）were 54.29%（57/105）and 31.43%（22/70）respectively,and mainly distributed in the trauma orthopedic department,accounting for 49.12%and45.45%respectively.The susceptibility rates of E.coli,K.pneumoniae,and E.cloacae to meropenem and imipenem were all 100.00%.The susceptibility rates of E.coli and K.pneumoniae to amikacin,piperacillin-tazobactam and amoxicillin/clavulanic acid were all〉80%.Susceptibility rate of E.cloacae to most antimicrobial agents were 71.26%-100.00% except for piperacillin（64.37%）.Susceptibility rates of P.aeruginosato most antimicrobial agents were〉85% except for cefepime（78.95%）and aztreonam（65.79%）.Conclusion Gram-negative bacilli are the most common pathogens in wound infection of orthopedics patients.In order to use antimicrobial agents rationally and improve clinical treatment effect,it is important to realize the distribution of pathogens and antimicrobial resistance.

关 键 词：骨科 伤口 革兰阴性杆菌 抗药性 微生物 耐药性 

分 类 号：R181.32[医药卫生—流行病学]