开放性骨折患者术后伤口感染的细菌学特点及对抗菌药物的耐药性分析  

Bacteriological characteristics of postoperative wound infections in open fracture patients and resistance to antibiotics

作　　者：金国华[1] 赵胜春[1] 陈欣[1] 陈红卫[1] 李军[1] 潘月好 

机构地区：[1]浙江省义乌市中心医院骨科,浙江义乌322000

出　　处：《中华医院感染学杂志》2017年第6期1321-1324,共4页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81000812)

摘　　要：目的调查分析开放性骨折患者术后伤口感染的细菌学特点及对抗菌药物的耐药性,为临床诊疗提供参考依据。方法选取2014年5月-2016年7月医院骨科收治的开放性骨折术后伤口感染患者232例,采集患者开放性骨折伤口的分泌物进行培养与鉴定,对其伤口感染情况进行调查,并对获得的菌株进行药敏试验,分析感染患者的细菌学特点及耐药情况,并进行统计分析。结果 232例患者中,211例患者细菌培养呈阳性,细菌检出率为90.9%;所有标本共分离出病原菌296株,革兰阴性菌,占61.8%;革兰阳性菌,占33.4%;真菌,占4.7%;伤口感染检出率最高3种病原菌依次为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌,分别占18.6%、17.2%、15.2%;对主要病原菌进行药敏试验,耐药率最高的药物为青霉素,耐药率均在75%以上,而耐药率最低的药物为万古霉素菌株,耐药率均低于2%,其次为亚安培南。结论开放性骨折患者术后伤口感染的病原菌主要以革兰阴性菌为主,其中检出率最高的病原菌分别为大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、表皮葡萄球菌、肺炎克雷伯菌及鲍氏不动杆菌,且各种病原菌对多种常见抗菌药物耐药率较高,其中耐药率最高的为青霉素,耐药率最低的为万古霉素,因此,临床医护人员应根据伤口病原菌培养情况及药敏结果进行合理用药方案的制定,以有效控制感染。OBJECTIVE To investigate the bacteriological characteristics of postoperative wound infections in open fracture patients and analyze the resistance to antibiotics so as to provide guidance for clinical treatment.METHODS A total of 232 open fracture patients with postoperative wound infections who were treated in the hospital from May 2014 to Jul 2016 were enrolled in the study.The wound secretions were collected from the patients for bacterial culture and identification,the incidence of wound infections was investigated,the drug susceptibility testing was performed for isolated bacteria,the bacteriological characteristics of the wound infections and resistance to antibiotics were observed,and the statistical analysis was performed.RESULTS The bacterial culture showed positive in 211 of 232patients,with the isolation rate of bacteria 90.9%.Totally 296 strains of pathogens were isolated from all of the specimens,of which 61.8% were gram-negative bacteria,33.4% were gram-positive bacteria,and 4.7% were fungi.Escherichia coli,Staphylococcus aureus,and Pseudomonas aeruginosa ranked the top 3species of pathogens isolated from the patients with wound infections,accounting for 18.6%,17.2%,and 15.2%,respectively.The result of the drug susceptibility testing for the major species of pathogens showed that the drug resistance rate to penicillin was the highest（more than 75%）and the drug resistance rate to vancomycin was the lowest（less than 2%）,followed by imipenem.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the postoperative wound infections in the open fracture patients;the isolation rates of E.coli,S.aureus,P.aeruginosa,Staphylococcus epidermidis,and Klebsiella pneumoniae are the highest;the drug resistance rate is highest to penicillin and lowest to vancomycin.Therefore,it is necessary for the clinicians to formulate rational drug administration programs based on the results of bacterial culture and drug susceptibility testing so as to effectively control the infections.

关 键 词：开放性骨折 伤口感染 细菌学特点 抗菌药物 耐药性 

分 类 号：R978.1[医药卫生—药品]