烧伤患者感染病原菌的分布与耐药性分析  

Distribution and drug resistance analysis of pathogenic bacteria in burn patients

作　　者：孟雪勇 孙佳玮 王诗琪 马周吉 谭谦[1] Meng Xueyong;Sun Jiawei;Wang Shiqi;Ma Zhouji;Tan Qian(Department of Burns and Plastic Surgery,the Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院烧伤整形科,210008

出　　处：《中国临床实用医学》2021年第4期34-38,共5页China Clinical Practical Medicine

基　　金：国家自然科学基金(81602773)。

摘　　要：目的分析烧伤患者感染病原菌分布与耐药性。方法选取2018年1月至2020年12月南京大学医学院附属鼓楼医院烧伤整形科收治的78例烧伤伴发感染患者,男52例,女26例,年龄(51.2±15.7)岁,年龄范围为26~83岁。对患者的临床资料(病原菌来源、药敏结果及耐药性)进行回顾性分析。结果不同来源标本共分离出病原菌279株,创面分泌物81.4%(227/279)、深静脉导管头9.7%(27/279)、痰培养6.4%(18/279)、血培养1.4%(4/279)、尿培养1.1%(3/279)。革兰氏阴性菌76.0%(212/279),革兰氏阳性菌20.8%(58/279),真菌3.2%(9/279)。革兰氏阴性菌是感染病原菌的主要组成部分,耐药情况较革兰氏阳性菌严重,其中多重耐药鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌对大部分常用抗菌药物耐药。革兰氏阳性菌对万古霉素、利奈唑胺、替加环素具有高敏感性,但对青霉素、苯唑西林、红霉素、克林霉素的耐药率较高。结论创面感染是烧伤患者感染的主要类型,感染病原菌主要是革兰氏阴性菌。定期监测病房中病原菌分布及其耐药性变迁,可为临床上合理应用抗菌药物提供有效的科学依据。Objective To investigate the distribution and drug resistance rate of pathogenic bacteria in burn patients with infection.Methods A retrospective analysis was performed on the distribution and drug sensitivity rates of pathogenic bacteria isolated from 78 burn patients with infection in the department of Burns and Plastic Surgery of the Affiliated Drum Tower Hospital,Medical School of Nanjing University from January 2018 to December 2020.There were 52 males and 26 females,with an average age of(51.2±15.7)years old,ranging from 26 to 83.The source of pathogenic bacteria,drug sensitivity results and drug resistance of the patients were retrospectively analyzed.Results A total of 279 strains of pathogens were isolated from different specimens,including wound secretions,deep vein catheter heads,sputum specimens,blood specimens,and urine specimens,accounting for 81.4%(227/279),9.7%(27/279),6.4%(18/279),1.4%(4/279),1.1%(3/279)respectively.Gram-negative(G-)bacteria 76.0%(212/279),Gram-positive(G)bacteria 20.8%(58/279)and fungi 3.2%(9/279).G-bacteria were the main components of the pathogens.The drug resistance of G-bacteria was more serious than that of Gbacteria.Multidrug-resistant Acinetobacter baumannii,Pseudomonas aeruginosa,and Klebsiella pneumoniae are resistant to most commonly used antimicrobials.Gbacteria showed high sensitivity to vancomycin,linezolid,and tigecycline,but high resistance to penicillin,oxacillin,erythromycin and clindamycin.Conclusion Wound infection is the main type of infection in burn patients,and the infecting pathogens are mainly G-bacteria.Regularly monitoring the distribution of pathogenic bacteria and the change of drug resistance in wards can provide effective scientific basis for rational application of antibiotics in clinical practice.

关 键 词：烧伤 感染 病原菌 革兰氏阴性菌 革兰氏阳性菌 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R644[医药卫生—临床医学]