创伤患者创面感染相关肠杆菌科细菌的耐药性分析  

Analysis of drug resistance of Enterobacteriaceae associated with wound infections in trauma patients

作　　者：谢朝云[1] 覃家露[1] 熊芸[1] 孙静[1] 杨怀[2] 杨忠玲 XIE Zhao-yun TAN Jia-lu XIONG Yun SUN Jing YANG Huai YANG Zhong-ling(The Third Affiliated Hospital of Guizhou Medical University, Tuyun, Guizhou 558000, Chin)

机构地区：[1]贵州医科大学第三附属医院感染管理科,贵州都匀558000 [2]贵州省人民医院感染管理科,贵州贵阳550002 [3]贵州医科大学第三附属医院检验科,贵州都匀558000

出　　处：《中华医院感染学杂志》2017年第12期2771-2774,共4页Chinese Journal of Nosocomiology

基　　金：贵州省科技厅联合基金资助项目(黔科合LH字[2014]7162);贵州省黔南州社会发展科技基金资助项目(黔南科合社字[2013]20)

摘　　要：目的了解创伤患者创面标本肠杆菌科细菌分布与耐药性变迁。方法收集2012-2016年医院各科患者伤口标本分离出肠杆菌科细菌1 757株,采用Phoenix-100全自动细菌鉴定药敏系统进行鉴定并测定MIC,结果参照美国临床和实验室标准化协会(CLSI)标准判断。WHONET5.6和SPSS20.0软件对实验结果进行统计分析。结果创伤患者创面标本分离肠杆菌科细菌以大肠埃希菌、阴沟肠杆菌和肺炎克雷伯菌为主,分别占58.61%、21.48%和7.25%;其对头孢唑林、四环素、磺胺甲噁唑/甲氧苄啶、氨苄青霉素、氨苄西林/舒巴坦、哌拉西林、头孢呋辛等抗菌药物的耐药率较高;对阿米卡星、哌拉西林/他唑巴坦、亚胺培南和美罗培南等耐药率较低;对左氧氟沙星、阿米卡星、环丙沙星、庆大霉素、妥布霉素等氨基糖甙类和喹诺酮类抗菌药物的耐药率显下降趋势(P<0.05);对头孢唑林、阿莫西林/克拉维酸、头孢西丁、哌拉西林/他唑巴坦等青霉素类、头孢菌素类和头霉素类及含酶抑制剂抗菌药物的耐药率呈上升趋势(P<0.05)。结论创伤患者创面感染肠杆菌科细菌的耐药性快速上升,得到了一定控制,但对部分常用抗菌药物仍现上升趋势,应继续采取有效控制措施。OBJECTIVE To investigate the distribution and drug resistance of Enterobacteriaceae isolated from wound specimens.METttODS A total of 1757 strains of Enterobacteriaceae were isolated from wound specimens of patients from 2012 to 2016 in our hospital,which were identified and determined by MIC Phoenix-100 automatic bacteria identification and drug sensitivity,and results were judged according to the Clinical and Laboratory Standards Institute （CLSI） standards.WHONET5.6 and SPSS20.0 software were used to analyze the experimental results.RESULTS Enterobacteriaceae isolated from the wounds were mainly Escherichia coli,Enterobacter cloacae and Klebsiella pneumoniae,accounting for 58.61%,21.48% and 7.25%,respectively.They had high drug resistant rates to cefazolin,tetracycline,sulfamethoxazole/ trimethoprim,ampicillin,ampicillin/sulbactam,piperacillin,cefuroxime and other antimicrobial agents,and had low drug resistant rates to amikacin,piperacillin/tazobactam,imipenem and meropenem.The drug resistant rates to aminoglycosides and quinolones of aevofloxacin,amikacin,ciprofloxacin,gentamicin and tohramycin were significantly decreased （P〈0.05）,and to penicillins,cephalosporins and cephamycins and antibiotics containing enzyme inhibitors of cefazolin,amoxicillin/clavulanic acid,cefoxitin and piperacillin/tazobactam were incresaed （P〈0.05）.CONCLUSION The rapid increase of drug resistance of Enterobacteriaceae in wound surface infection has been controlled,but the drug resistant rates to some of the commonly used antibiotics are still increased,which should continue to take effective control measures.

关 键 词：创伤患者 创面 肠杆菌科细菌 耐药性变迁 

分 类 号：R641[医药卫生—外科学]