四肢伤口分泌液中病原菌耐药性与抗菌药物早期应用调查  

Investigation of Drug Resistance of Major Pathogens in Extremity Wound Secretions and Evaluation of Early Application of Antibacterial Drugs

作　　者：林传辉 关钦强 何步高 廖传芳 LIN Chuanhui;GUAN Qinqiang;HE Bugao;LIAO Chuanfang(Department of Pharmacy,Xinhui District,Jiangmen City,Jiangmen,Guangdong 529159,China;Department of Orthopedics,Xinhui District,Jiangmen City,Jiangmen,Guangdong 529159,China;Department of Laboratory,Siqian People's Hospital,Xinhui District,Jiangmen City,Jiangmen,Guangdong 529159,China)

机构地区：[1]江门市新会区司前人民医院药剂科,广东江门529159 [2]江门市新会区司前人民医院骨伤科,广东江门529159 [3]江门市新会区司前人民医院检验科,广东江门529159

出　　处：《今日药学》2020年第6期423-426,432,共5页Pharmacy Today

摘　　要：目的调查并分析四肢创伤术后感染伤口分泌液中主要病原菌对抗菌药物的耐药性以及早期抗菌药物应用情况。方法选择2016~2019年于我院骨伤科就诊的409例四肢创伤住院患者作为本次研究对象,收集其创口分泌液并进行病原菌分离与培养,采用RapIDTM鉴定系统进行细菌鉴定,纸片琼脂扩散法(K-B法)进行药敏实验。结果409例四肢创伤患者的伤口分泌液样本中共检出病原菌株228株,检出率55.75%,主要为大肠埃希菌、不动杆菌、铜绿假单胞菌、变形杆菌、表皮葡萄球菌,各伤口部位感染率从高到低依次为手指、小腿、足背、大腿、足跟;检出菌株中有126例占比55.26%在细菌培养前使用的抗菌药物品显现耐药性,使用主要品种为克林霉素、头孢呋辛、头孢唑林、青霉素、左氧氟沙星;其中Ⅰ类切口术后感染菌株13例,预防用药品种:青霉素、克林霉素、头孢呋辛。结论我院患者四肢创伤术后感染主要致病菌为革兰阴性菌,术后感染与早期抗菌药物应用不合理有关,临床药师应根据本院药敏试验结果,提高临床思维能力,协助各级医师合理使用抗菌药物,预防并降低患者四肢创伤术后感染发生,规范临床抗菌药物的使用。OBJECTIVE To investigate and analyze the antimicrobial resistance of major pathogens in infected wound exudates and the application of early antibacterial drugs.METHODS A total of 409 inpatients with limb trauma who were treated in our hospital's orthopedic department from 2016 to 2019 were selected.The wound secretion was collected,and pathogenic bacteria were isolated and cultured.Bacteria identification was performed using the RapIDTM identification system,and the drug sensitivity test was performed by the paper agar diffusion method(K-B method).RESULTS A total of 228 pathogenic strains were detected in the wound secretion samples from 409 patients with limb trauma.The detection rate was 55.75%,mainly E.coli,Acinetobacter,Pseudomonas aeruginosa,Proteus,Staphylococcus epidermidis.The infection rate of each wound site was from finger to leg,leg,back of foot,thigh,and heel.Among the detected strains,126 cases accounted for 55.26%of the antibacterial drugs used before bacterial culture showed drug resistance.The main varieties used were clindamycin,cefuroxime,cefazolin,penicillin,and levofloxacin.Among them,13 cases were infected with type I incisions after surgery,and the preventive drugs were penicillin,clindamycin,and cefuroxime.CONCLUSION Gram-negative bacteria are the main pathogens in post-traumatic infection of patients in our hospital.Postoperative infections are related to the unreasonable application of early antibacterial drugs.Clinical pharmacists should assist physicians in selecting appropriate antibacterial drugs based on the results of drug sensitivity tests,so as to prevent and reduce the incidence of postoperative infections in patients with limb trauma,and standardize the use of clinical antibacterial drugs.

关 键 词：四肢创伤 伤口分泌液 耐药性 抗菌药物 病原菌 

分 类 号：R969[医药卫生—药理学]