上肢骨折患者术后伤口感染细菌种类与药敏分析  

Distribution and drug susceptibility of pathogens causing postoperative wound infection in patients with upper limb fracture

作　　者：万峰格[1] 邹吉锋[1] 曹海云[2] 田静娟[3] 焦瑞娜[4] 

机构地区：[1]河南省洛阳正骨医院河南省骨科医院膝部损伤二科上肢损伤二科,河南洛阳471000 [2]河南省洛阳正骨医院河南省骨科医院脊柱外科,河南洛阳471000 [3]河南省洛阳正骨医院河南省骨科医院髋部损伤四科,河南洛阳471000 [4]河南省洛阳正骨医院河南省骨科医院ICU,河南洛阳471000

出　　处：《中华医院感染学杂志》2017年第9期2068-2071,共4页Chinese Journal of Nosocomiology

摘　　要：目的筛查上肢骨折患者术后伤口感染细菌种类分布特点、分析药敏结果,旨在降低耐药菌株产生、控制感染,为临床合理选取抗菌药物提供细菌学参考依据。方法选取2014-2016年372例上肢骨折术后伤口感染患者,比较2014、2015年和2016年伤口细菌种类及分布、主要革兰阳性菌、革兰阴性菌药敏试验结果。结果检出病原菌370株,3年内细菌种类及分布比较,差异无统计学意义;每个年度内,金黄色葡萄球菌百分比高于其他阳性菌株检出率,铜绿假单胞菌百分比高于其他阴性菌株检出率,差异有统计学意义(P<0.05);2015、2016年与2014年比较,金黄色葡萄球菌对氨苄西林、氧氟沙星耐药率,表皮葡萄球菌对氨苄西林、莫西沙星耐药率,差异有统计学意义(P<0.05);2014年,金黄色葡萄球菌、表皮葡萄球菌对青霉素耐药率高于本年度其他类别抗菌药物,2015、2016年,对青霉素和氨苄西林耐药率高于其他抗菌药物,差异有统计学意义(P<0.05);2015年鲍氏不动杆菌对亚胺培南、美罗培南、氧氟沙星耐药率与2014年比较,差异有统计学意义(P<0.05);2016年与2015年比较,鲍氏不动杆菌对头孢哌酮/舒巴坦耐药率,差异有统计学意义(P<0.05);且各年度内铜绿假单胞菌对氨苄西林耐药率与其他抗菌药物比较,差异有统计学意义(P<0.05),鲍氏不动杆菌对头孢曲松、头孢他啶、头孢吡肟、庆大霉素、阿米卡星和环丙沙星耐药率,差异有统计学意义(P<0.05)。结论加强上肢骨折患者术后伤口感染观察、及时筛查创面病菌种类分布信息,根据药敏结果选取合理抗菌药物,有助于控制感染、促进伤口愈合。OBJECTIVE To observe the distribution and drug susceptibility of pathogens causing postoperative wound infection in patients with upper limb fracture,reduce the drug-resistant strains,and control the infection so as to provide bacteriological basis for reasonable clinical use of antibiotics.METHODS From 2014 to 2016,a total of 372 upper limb fracture patients who had the postoperative wound infection were enrolled in the study.The distribution of pathogens and the result of drug susceptibility testing for major species of gram-positive bacteria and gram-negative bacteria were observed and compared among 2014,2015,and 2016.RESULTS Totally 370 strains of pathogens were isolated,and there was no significant difference in the distribution of species of the pathogens among the three years.The percentage of Staphylococcus aureus was significantly higher than the isolation rate of other positive strains in each year,the percentage of Pseudomonas aeruginosa was significantly higher than the isolation rate of other negative strains（P〈0.05）.There was significant difference in the drug resistance rate of S.aureus to ampicillin and levofloxacin or the drug resistance rate of Staphylococcus epidermidis to ampicillin and moxifloxacin between 2015,2016,and 2014（P〈0.05）.The drug resistance rate of the S.aureus and S.epidermidis was significantly higher to penicillin than to other kinds of antibiotics in 2014;the drug resistance rates of the strains were significantly higher to penicillin and ampicillin than to other kinds of antibiotics in 2015 and 2016（P〈0.05）.There was significant difference in the drug resistance rate of the A.baumannii strains to imipenem,meropenem,or levofloxacin between 2015 and 2014（P〈0.05）;there was significant difference in the drug resistance rate of the A.baumannii strains to cefoperazone-sulbactam between 2016 and 2015（P〈0.05）;there was significant difference between the drug resistance rate of the P.aeruginosastrains to ampicillin and the drug resistance rate to other a

关 键 词：上肢 骨折 创面 细菌 药敏 

分 类 号：R683.41[医药卫生—骨科学]