关节腔感染患者病原菌分布与耐药特征  

Distribution and drug resistance of pathogens isolated from patients with joint cavity infections

作　　者：彭星[1] 段瑞[1] 苍成友[1] 李辉喜[1] 钟诗春 

机构地区：[1]贵阳市第一人民医院麻醉疼痛科,贵州贵阳550002

出　　处：《中华医院感染学杂志》2016年第13期3043-3045,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨关节腔感染患者病原菌分布及耐药特征,为感染防治提供参考。方法回顾性分析2012年8月-2015年8月于医院治疗1 000例关节病变患者临床资料,所有患者均行膝关节腔穿刺术及关节腔注射,收集发生关节腔感染患者样本,接种于血培养瓶中,分析医院感染率、病原菌构成及对抗菌药物耐药性;收集患者发生医院感染相关资料,比较导致感染的危险因素。结果 1 000例患者中发生关节腔感染60例,感染率6.0%;共分离出75株病原菌,其中革兰阳性菌35株(46.7%),革兰阴性菌31株(41.3%),真菌9株(12.0%);革兰阳性菌对万古霉素耐药率较低,革兰阴性菌对亚胺培南、美罗培南耐药率较低;年龄≥60岁、有糖尿病史、关节腔穿刺操作不规范患者,发生关节腔感染率显著上升,差异有统计学意义(P<0.05)。结论革兰阳性菌是关节腔感染的主要病原菌,病原菌对常用抗菌药物均显示出较高的耐药率,因此对于关节腔感染患者,应根据药敏试验结果选择敏感性较高的抗菌药物,提高感染防治效果。OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from the patients with joint cavity infections so as to provide guidance for prevention and treatment of the infections.METHODS The clinical data that were collected from 1 000 patients with joint diseases who were treated in the hospital from Aug 2012 to Aug 2015 were retrospectively analyzed.All of the patients received knee joint cavity puncture and articular injection,the specimens were collected from the patients with joint cavity infections and were inoculated in blood culture bottle.The incidence of nosocomial infections,constituent ratios of pathogens,and drug resistance were recorded;the relevant data of nosocomial infections were collected,and the risk factors for the infections were observed and compared.RESULTS Of 1 000 patients,60had the joint cavity infections,with the infection rate6.0%.A total of 75 strains of pathogens were isolated,including 35（46.7%）strains of gram-positive bacteria,31（41.3%）strains of gram-negative bacteria,and 9（12.0%）strains of fungi.The drug resistance rate of the gram-positive bacteria to vancomycin was relatively low;the drug resistance rates of the gram-negative bacteria to imipenem and meropenem were relatively low.The incidence of joint cavity infections was significantly increased in the patients with more than 60 years of age,the patients with history of diabetic mellitus,or the patients without receiving standard joint cavity puncture（P〈0.05）.CONCLUSION The gram-positive bacteria are dominant among the pathogens causing the joint cavity infections;the pathogens are highly resistant to the commonly used antibiotics.It is necessary for the patients with joint cavity infections to choose sensitive antibiotics based on the result of the drug susceptibility testing so as to improve the effect on prevention and treatment of the infections.

关 键 词：关节腔 感染 病原菌 耐药性 药敏试验 

分 类 号：R378[医药卫生—病原生物学]