2014—2015年烧伤科细菌耐药情况及临床对策分析  

Monitoring reports and clinical countermeasure analysis on bacterial resistance in the Department of Burn from 2014 to 2015

作　　者：杨磊[1] 张刚[1] 卢秋成[1] 蒋章佳[1] 焦献功[1] 刘友红[1] 涂赤辉[1] 周阳[1] 李锋[1] 欧阳显文 周杰民[1] 罗瞳[1] 卢显冬 李红[1] 陈红建[1] 夏珍[1] 

机构地区：[1]湖南省浏阳市人民医院烧伤整形外科,湖南浏阳410300

出　　处：《感染．炎症．修复》2016年第2期89-94,共6页Infection Inflammation Repair

摘　　要：目的:分析2014-2015年湖南省浏阳市人民医院烧伤科细菌流行变迁及耐药的相关因素,从而指导临床合理用药。方法:对2014年1月—2015年12月于湖南省浏阳市人民医院住院治疗的烧伤患者创面培养病原菌(943株)以及药敏试验结果进行分析比较。结果:2014年铜绿假单胞菌为绝对优势菌,2015年优势菌群不明显,但鲍曼不动杆菌所占构成比增加。鲍曼不动杆菌对碳青酶烯类耐药率并没有随着药物用量下降而下降;铜绿假单胞菌随着碳青酶烯类抗生素使用量的下降,耐药率在下降;头孢哌酮/舒巴坦、碳青酶烯类抗生素对阴沟肠杆菌依然敏感,头孢类、半合成青霉素、喹诺酮耐药率在上升;头孢哌酮/舒巴坦、碳青酶烯类抗生素对肺炎克雷伯菌依然敏感,头孢类变化不大,喹诺酮耐药率在下降;头孢哌酮/舒巴坦、碳青酶烯类抗生素对大肠埃希菌依然敏感。结论:2014年耐药菌以铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌、肺炎克雷伯菌布为主,2015年耐药菌以鲍曼不动杆菌、肺炎克雷伯杆菌,金黄色葡萄球菌等菌分布为主。鲍曼不动杆菌、阴沟肠杆菌、肺炎克雷伯菌对阿米卡星耐药率有差异,铜绿假单胞菌对大部分抗生素耐药率有差异,大肠埃希菌对大部分抗生素耐药无明显差异。2015年较2014年治愈好转率高。Objective：To analyze the changes of bacterial floras and their drug resistance in the Burn Department ofLiuyang People’s Hospital of Hunan Province, thereby to guide the rational clinical medication of antibiotics. Methods：Nine hundred and forty-three strains of pathogenic bacteria, isolated from the wounds of burn patients admitted in the BurnDepartment of Liuyang People’s Hospital of Hunan Province from Jan. 2014 to Dec. 2015, and the drug sensitivity testresults were analyzed. Results： Pseudomonas aeruginosa was the absolutely dominant bacteria in 2014 among the pathogens,while no obviously dominant bacteria in 2015, but the infective rate of Acinetobacter baumannii increased. The resistantrate of Acinetobacter baumannii to carbapenems didn’t declined along with the decrease of the amount of drug usage, butof Pseudomonas aeruginosa to carbapenem declined with the decrease of the amount of carbapenem usage. Enterobactercloacae were still sensitive to cefoperazone/sulperazon and carbapenems antibiotics, while showed increased resistanceto cephalosporins, semi-synthetic penicillin and quinolones. Klebsiella pneumonia was still sensitive to cefoperazone/sulperazon and carbapenems antibiotics, with no obvious change in resistance to cephalosporins, but with declined resistanceto quinolones. Escherichia coli were still sensitive to cefoperazone/sulperazon and carbapenem antibiotics. Conclusions：Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii and Klebsiella bacillus are the main drugresistantbacteria in 2014, and Acinetobacter baumannii, Klebsiella bacillus and Staphylococcus aureus are the main drugresistantbacteria in 2015. The differences of drug resistance to amikacin exist among Acinetobacter baumannii, Enterobactercloacae and Klebsiella bacillus, and the resistance of Pseudomonas aeruginosa to most of antibiotics is different. No obviousdifference exists in the resistance of Escherichia coli to most antibiotics. For the patients with wound infection, the curedand improvement

关 键 词：烧伤科 细菌 感染 耐药性 药敏试验 

分 类 号：R969.3[医药卫生—药理学]