慢性下肢静脉曲张性溃疡病原菌及其药物敏感性  

Pathogens isolated from patients with chronic lower extremity varicose ulcers and drug susceptibility testing

作　　者：李楠[1] 张秀军[1] 李俊海[1] 刘存发[1] 黄俊杰[1] 赵子源[1] 肖磊[1] 刘立国 孔敬波[1] LI Nan;ZHANG Xiu-jun;LI Jun-hai;LIU Cun-fa;HUANG Jun-jie;ZHAO Zi-yuan;XIAO Lei;LIU Li-guo;KONG Jing-bo(Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津医院血管外科二病区,天津300211

出　　处：《中华医院感染学杂志》2021年第13期2036-2040,共5页Chinese Journal of Nosocomiology

基　　金：天津市自然科学基金资助项目(2019286)。

摘　　要：目的探讨慢性下肢静脉曲张性溃疡患者致病菌及其药物敏感性。方法收集天津医院2017年10月-2019年10月收治的123例慢性下肢静脉曲张性溃疡患者临床资料进行回顾性分析,分析患者感染病原菌分布及其药敏性。结果慢性下肢静脉曲张性溃疡患者男性69例、年龄(≥60岁)67例、右下肢溃疡55例、溃疡面积(≥10 cm^(2))71例、并发静脉淤积性皮炎79例、C-反应蛋白(CRP)(>10 mg/L)63例、中性粒细胞(>75%)43例、白细胞(WBC)(>10×10^(9)/L)71例、降钙素原(PCT)(>10 ng/ml)51例;分离鉴定病原菌146株,革兰阴性菌86株、革兰阳性菌57株、真菌3株。革兰阴性菌中铜绿假单胞菌29株、大肠埃希菌13株,革兰阳性菌中金黄色葡萄球菌39株、凝固酶阴性葡萄球菌12株。铜绿假单胞菌对哌拉西林敏感29株,呋喃妥因敏感7株;金黄色葡萄球菌对万古霉素、利奈唑胺、呋喃妥因、莫西沙星、利福平敏感39株,红霉素、克林霉素、青霉素敏感11株、8株、0株;大肠埃希菌对亚胺培南、美罗培南敏感均为13株,对哌拉西林、氨苄西林敏感5株、3株。结论慢性下肢静脉曲张性溃疡好发于老年人,溃疡面感染病原菌以铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌为主,根据病原菌药敏性特点合理选择抗菌药物,避免滥用。OBJECTIVE To explore the pathogens isolated from the patients with chronic lower extremity varicose ulcers(LEVU) and analyze the changes of drug susceptibility. METHODS The clinical data were collected from 123 patients with chronic LEVU who were treated in the Tianjin Hospital from Oct 2017 to Oct 2019 and were retrospectively analyzed. The distribution and drug susceptibility of the pathogens were observed. RESULTS Among the patients with chronic LEVU, 69 were males, 67 were more than 60 years old, 55 had ulcers of right lower extremity, 71 had area of ulcer no less than 10 cm^(2), and 79 were complicated with venous stasis dermatitis;there were 63 patients with the C-reactive protein more than 10 mg/L, 43 patients with the percentage of neutrophils more than 75%, 71 patients with white blood cell counts more than 10×10^(9)/L, and 51 patients with procalcitonin more than 10 ng/ml. A total of 146 strains of pathogens were isolated, 86 of which were gram-negative bacteria, 57 were gram-positive bacteria, and 3 were fungi. Among the gram-negative bacteria, there were 29 strains of Pseudomonas aeruginosa and 13 strains of Escherichia coli;Among the gram-positive bacteria, there were 39 strains of Staphylococcus aureus and 12 strains of coagulase-negative Staphylococcus. There were 29 strains of P.aeruginosa that were sensitive to piperacillin and 7 strains that were sensitive to nitrofurantoin;there were 39 strains of S.aureus that were sensitive to vancomycin, linezolid, nitrofurantoin, moxifloxacin and rifampicin, 11 strains that were sensitive to erythromycin, 8 strains that were sensitive to clindamycin, and 0 strain that was sensitive to penicillin;there were 13 strains of Escherichia coli that were sensitive to imipenem, 13 strains that were sensitive to meropenem, 5 strains that were sensitive to piperacillin, and 3 strains that were sensitive to ampicillin. CONCLUSION Chronic LEVU is prevalent in the elderly. The P.aeruginosa, S.aureus and E.coli are dominant among the pathogens causing ulcer infection, an

关 键 词：慢性下肢静脉曲张 溃疡 感染病原菌 药敏性 

分 类 号：R543.6[医药卫生—心血管疾病]