皖南地区898例糖尿病足病及烧烫伤创面分泌物培养病原菌及耐药分析  

Epidemiology and antimicrobial resistance profiles of pathogens in diabetic foot infection as well as burn and scald wound infections(898 cases) in southern Anhui province

作　　者：高家林[1] 张魏[2] 刘春声[3] 朱玉[4] 夏礼斌 陈月平[1] 赵咏莉[1] 何春玲[1] 邢春燕[1] 王勇[1] 张斌华[1] 陶秀彬[5] 

机构地区：[1]皖南医学院弋矶山医院内分泌科 [2]皖南医学院弋矶山医院微机中心 [3]皖南医学院弋矶山医院检验科 [4]皖南医学院公共卫生学院流行病与卫生统计学教研室 [5]皖南医学院弋矶山医院感染管理科

出　　处：《中国临床药理学与治疗学》2016年第7期796-801,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：安徽省高校优秀青年人才计划资助项目(2014-181));国家自然科学基金项目(81200632;81471002);安徽省自然科学基金(1508085MH149)

摘　　要：目的:分析本院糖尿病足和烧烫伤创面感染患者病灶分泌物培养病原菌和耐药情况,为临床治疗、院感防控提供依据资料。方法:对2012年1月-2016年5月本地区898例糖尿病足病及烧烫伤感染创面分泌物培养病原菌及药敏数据进行汇总,回顾性分析病原菌株分布,耐药情况,利用Kruskal-Wallis检验分析病原菌年龄分布差异的相关性。结果:共898例次样本,698人次分离出病原菌株,240例次未分离出病原菌,有效分离率73.27%,创面呈现多种菌混合感染的趋势,检测到两种菌的比例占18.37%。病原菌分布以G-菌为主,共550株,占66.34%,主要构成依次为铜绿假单胞菌(17.01%)、鲍曼不动杆菌(16.52%)、大肠埃希菌(11.22%)、肺炎克雷伯菌(5.79%)。G+球菌272株,占32.81%,主要为金黄色葡萄球菌(12.9%)、表皮葡萄球菌(6.99%)。主要G-菌对一、二代头孢菌素均高度耐药,对三、四代头孢、氨基糖苷类耐药率相对较低。在半合成青霉素中,大部分G-菌对哌拉西林/他唑巴坦仍保持一定敏感性。除鲍曼不动杆菌外,主要G-菌对亚胺培南仍具有高度敏感性。主要G+菌,除对青霉素高耐药外,对其余大部分抗生素仍保持不同程度的敏感性。不同病原菌年龄分布差异相关性分析表明,多数病原菌感染具有年龄分布的显著性差异。结论:皖南地区近5年糖尿病足病感染及烧烫伤创面的病原菌分布具有地区特异性,其耐药情况,年龄分布差异分析有助于区域内的院感防控。ABSTRACT AIM： To provide the basis for clini- cal treatment and prevention of hospital infection by analyzing the distribution of pathogenic bacteria and antibiotic resistance in diabetic foot infection as well as burn and scald wound infections. METHODS： Culture specimens and drug susceptibility data of 898 cases of diabetic foot infection as well as burn and scald wound infections from January 2012 to May 2016 were collected to analyze the pathogens distribution and antibiotics resistance. Kruskal-Wal- lis tests were used to analyze the correlation of age distribution of pathogenic bacteria. RESULTS： Of the 898 specimens, 698 of bacteria strains were iso- lated, while 240 specimens were without outcomes, the isolation rate were 73.27%. Detected strains, mainly form gram-negative （G ） bacteria, were Pseudomonas aeruginosa （ 17.01% ） , Bauman Acinetobacter （ 16.52% ）, Escherichia coli （11.22%）, Klebsiella pneumoniae （5.79%）. The distributions of gram-positive （G＋） bacteria （272 strains, 32.81% ） were mainly from Staphylo- coccus aureus （ 12.9% ）, Staphylococcus aureus （6.99%）. Most G- bacteria were detected resistant to the first and second generation cephalosporins while the third and fourth generation cephalosporins remain strong against it. Most G- bacteria, in semi synthetic penicillin only have good sensitivity to pip- eracillin-tazobactam. Most G- bacteria except Acine- tobacter Bauman have good sensitivity to imiperem, while most G ＋ bacteria have sensitivity to most anti- biotics except penicillin. Correlation analysis showed that most pathogenic bacteria had significant different age distribution among each other. CONCLUSION： The distribution of pathogenic bacteria in southern Anhui province from recent five years show regional specificity in diabetic foot infection as well as burn and scald wound infections, and study on their antibiotic resistance and age distribution could be referential for preventing hospital infection.

关 键 词：糖尿病足 烧烫伤 创面感染 病原菌 耐药性 

分 类 号：R587.1[医药卫生—内分泌]