创面分泌物病原菌的分布及危险因素分析  

Distribution of pathogenic bacteria isolated from wound secretion and the risk factors

作　　者：陈宝花[1] 倪俊[1] 许献荣[1] 祝云昭 陈瑞彩[1] 王滢[1] 

机构地区：[1]中国人民解放军第八五医院烧伤整形外科,上海200052

出　　处：《中国微生态学杂志》2016年第12期1412-1415,共4页Chinese Journal of Microecology

基　　金：上海市卫生局科研基金(20134489);上海市中医药科研基金(2014LP033A)

摘　　要：目的分析烧伤外科患者创面分泌物病原菌的分布及感染危险因素,为临床防控提供理论依据。方法采用回顾性分析方法,收集2012年至2014年期间本院烧伤外科住院患者的临床细菌学资料,分析创面病原菌的分布。根据创面分泌物细菌培养结果分为病原菌阴性组和阳性组,对比两组患者临床资料,分析创面分泌物病原菌阳性的相关危险因素,并采用非条件Logistic回归法分析独立危险因素。结果创面分泌物培养401次,阳性结果302次(75.31%)。分离出315株病原菌,其中革兰阳性菌148株(46.98%),革兰阴性菌167株(53.02%)。常见病原菌为:金黄色葡萄球菌(37.46%)、铜绿假单胞菌(23.81%)、大肠埃希菌(8.89%)、粪肠球菌(5.08%)、肺炎克雷伯杆菌(5.08%)。255例患者纳入研究,其中创面分泌物病原菌阴性组92例(36.08%),阳性组163例(63.92%)。单因素分析显示:住院史、危重症、创面深度、难愈性创面、血红蛋白、近期导管植入、近期输液、近期手术、近期抗菌药物治疗是创面分泌物病原菌阳性的相关危险因素(P<0.05)。多因素Logistic回归分析显示:难愈性创面和近期抗菌药物治疗是创面分泌物病原菌阳性的独立危险因素(P<0.05)。结论创面分泌物病原菌分布广泛,金黄色葡萄球菌和铜绿假单胞菌是常见菌。难愈性创面和近期抗菌药物治疗与创面分泌物病原菌阳性有关。Objective To analyze the distribution of pathogenic bacteria isolated from wound and the risk factors so that to provide theoretical foundation for clinical prevention and control. Methods The clinical bacteriology data of patients in the burn wards from January 2012 to December 2014 were collected to retrospectively analyze the distribution of pathogenic bacteria isolated from wound secretion. According to the results of pathogenic bacterial culture, the patients were divided into the positive group or negative group. Univariate analysis and logistic regression were performed to analyze the risk factors. Results A total of 401 clinical samples were analyzed, and 302 （75.31~） of them were bacteria-positive. 315 strains of pathogenic bacteria were isolated, among which Gram positive bacteria and gram negative bacteria accounted for 46.98% and 53. 02%, respectively. The common pathogenic bacteria were Staphylococcus aureus （37.46%）, Pseudornonas aeruginosa （23.81 %） , Escherichia coli （8.89 % ）, Enterococcus faecalis （5.08%） and Klebsiella pneumoniae （5.08%） . 255 patients were included in the study, of which 92 patients （36.08%） were in the negative group while 163 （63.92%） were in the positive group. Univariate analysis showed that history of hospitalization, critical illness, wound depth, refractory wound, hemoglobin, recent catheterization, recent infusion, recent surgery and recent use of antibacterial drugs were associated with pathogenic bacteria isolation （P〈0. 05） . Multiple logistic regression analysis showed that refractory wound and recent use of antibacterial drugs were the strongest predictor for pathogenic bacteria isolation from wound secretion （P〈0.05） . Conclusion The pathogens isolated from wound secretion are diverse. Staphylococcus aureus and Pseudornonas aeruginosa are the most common pathogenic bacteria. Refractory wound and recent use of antibacterial drugs were significantly associated with pathogenic bacteria isolation from wound secretion.

关 键 词：创面 病原菌 危险因素 感染控制 

分 类 号：R378[医药卫生—病原生物学]