皮肤及皮肤结构感染细菌种类及耐药性分析  

A study of bacterial distribution and drug resistance in skin and soft tissue infection

作　　者：冼伟 杨凡 李东明[1] 孙婷婷[1] 尚盼盼[1] 郑佳佳[3] 彭宜红[4] Xian Wei;Yang Fan;Li Dongming;Sun Tingting;Shang Panpan;Zheng Jiajia;Peng Yihong(Department of Dermatology,Peking University Third Hospital,Beijing 100191,China;School of Basic Medical Sciences,Peking University Health Science Center,Beijing 100191,China;Clinical Laboratory,Peking University Third Hospital,Beijing 100191,China;Department of Microbiology,Peking University Health Science Center,Beijing 100191,China)

机构地区：[1]北京大学第三医院皮肤科,北京100191 [2]北京大学基础医学院,北京100191 [3]北京大学第三医院检验科,北京100191 [4]北京大学基础医学院病原生物学系,北京100191

出　　处：《中华医学杂志》2019年第11期829-833,共5页National Medical Journal of China

基　　金：国家自然科学基金(H81571967,C31770013).

摘　　要：目的探讨皮肤及软组织感染病灶分离细菌的多样性及耐药性,为临床合理使用抗菌药物提供科学依据。方法收集2012年1月至2017年12月北京大学临床医学院皮肤科皮肤及软组织感染病灶标本,包括脓液、分泌物、组织、尿液、咽拭子或肺泡灌洗液等,应用VITEK2Compact全自动微生物分析系统及BD-BrukerMALDIBiotyper微生物质谱快速鉴定系统进行细菌鉴定,K-B法进行药敏试验,结果按CLSI标准判读,并结合患者病例资料进行回顾性分析。结果327例患者标本中分离获得392株细菌,分别归属于21个属,56个种;其中革兰阳性球菌225株(占57.40%),革兰阴性杆菌114株(占29.08%),革兰阳性杆菌46株(占11.73%),革兰阴性球菌7株(占1.79%)。细菌检出前3位的依次是金黄色葡萄球菌(91株,占23.21%),表皮葡萄球菌(42株,占10.71%),铜绿假单胞菌(24株,占6.12%)。分离到的葡萄球菌对青霉素、红霉素有较高耐药率(>50%);革兰阴性杆菌则对氨苄西林耐药率高(86.1%),对二代和部分三代头孢也部分耐药性(约50%)。此外,耐甲氧西林金黄色葡萄球菌(MRSA)和甲氧西林敏感金黄色葡萄球菌(MSSA)仅在四环素耐药性方面差异有统计学意义(P<0.05)。结论自皮肤及软组织感染病灶分离的细菌种属多样性丰富,且较普遍存在对抗生素耐药问题,后者可能是导致难治性皮肤软组织感染的重要因素,提示临床应根据药敏试验结果合理选用抗菌药物进行治疗。Objective To investigate pathogenic bacteria and drug resistance in the patients with skin and soft tissue infection in order to provide the scientific evidences for clinical reasonable use of antibiotics.MethodsA retrospective analysis was performed on patients with skin and soft tissue infections in Department of Dermatology,Peking University Third Hospital from January 2012 to December 2017.Pus,secretions,skin lesions,urine,throat swabs,and alveolar lavage fluid were collected for bacterial culture,bacterial species were identified by VITEK2 Compact system and BD-Bruker MALDI Biotyper system.Drug resistance was detected by K-B agar diffusion method recommended by CLSI.ResultsA total of 392 strains of bacteria were isolated from 327 patients distributed in 21 genus and 56 species,of which 225 were gram-positive cocci(57.40%),114 were gram-negative rods(29.08%),46 were gram-positive rods(11.73%),and 7 were gram-negative cocci(1.79%).The top 3 bacteria were Staphylococcus aureus 91(23.21%),Staphylococcus epidermidis 42(10.71%),and Pseudomonas aeruginosa 24(6.12%).Staphylococcus had a high rate of resistance to penicillin and erythromycin(>50%).Gram-negative rods were resistant to ampicillin(86.1%),and also had certain resistance to most second-generation and some third-generation cephalosporin(about 50%).There was no significant change in the drug resistance rate of MRSA compared to MSSA.Only the resistance rate to tetracycline was statistically different(P<0.05).ConclusionThe emergence of drug-resistant strains is an important factor leading to refractory infections.There are a wide range of pathogenic bacteria species among the skin and soft tissue infection patients,and antimicrobial drugs should be chosen wisely according to drug sensitivity.

关 键 词：皮肤疾病 细菌性 软组织感染 微生物敏感性试验 抗菌药 耐药性 

分 类 号：R446.5[医药卫生—诊断学]