手指离断伤患者创口病原菌特点及治疗药物选择策略  

Characteristics of wound pathogens and drug treatment strategies in patients with severed fingers

作　　者：陈锡创 尤晓红 孙少君 王秋波 洪远芮 永军 Chen Xichuang;You Xiaohong;Sun Shaojun;Wang Qiubo;Hong Yuan;Rui Yongjun(Department of Pharmacy,Wuxi 9th People's Hospital,Wuri 214062,China;Department of Clinical Laboralory,Wuxi 9th People's Hospital,Wuxi 214062,China;Department of Pharmacy,Wuxi Children's Hospital,Wuxi 214023,China;Department of Hand Surgery,Wuxi 9th People's Hospital,Wuxi 214062,China)

机构地区：[1]无锡市第九人民医院药学部,无锡214062 [2]无锡市第九人民医院检验科,无锡214062 [3]无锡市儿童医院药学部,无锡214023 [4]无锡市第九人民医院手外科,无锡214062

出　　处：《中华手外科杂志》2023年第3期256-261,共6页Chinese Journal of Hand Surgery

基　　金：无锡市太湖人才计划高层次人才培养项目(HB2020115、BJ2020087);江苏省药学会科研项目(A202018)。

摘　　要：目的分析探讨手指离断伤患者创口常见病原菌及其耐药性等特点,为临床防治该类疾病经验性选择抗菌药物提供参考.方法回顾性分析我院手外科自2018年1月至2022年5月收治的3743例手指离断伤患者的基本信息、创口分泌物微生物培养情况及药物敏感结果,结合相关指南、共识等给予经验性治疗用药策略的推荐.结果这些患者创口分泌物培养共检测出1064株细菌生长,其中754株考虑为致病菌,包括革兰阴性(G-)菌425株(占56.4%),革兰阳性(G+)菌282株(占37.4%),真菌47株(占6.2%).患者年龄为(47.0±12.5)岁,男女比例为3∶1.G+、G-菌检出组患者创口分泌物采集时间分别为(3.82±2.19)h、(4.54±3.55)h,差异有统计学意义.受伤机制为机器绞伤、卷伤等,G-菌检出率有所增加.检出的G-菌主要有阴沟肠杆菌、鲍曼不动杆菌、铜绿假单胞菌等,可经验性选择阿米卡星、左氧氟沙星、哌拉西林钠他唑巴坦、头孢他啶等;检出的G+菌主要为葡萄球菌属,可经验性选择夫西地酸、利福平、莫匹罗星、四环素、妥布霉素等,但不建议使用β-内酰胺类抗菌药物.结论对于手指离断伤患者的经验性治疗除了需要考虑葡萄球菌属的感染之外,对于创口分泌物采集时间较长、受伤程度严重,还需要覆盖G-菌,并结合其耐药特点,恰当选择合适的药物.Objective To analyze and discuss the characteristics of common pathogens and their drug resistance in patients with finger amputation wound,so as to provide reference for empirically selecting antibiotics for clinical prevention and treatment of such diseases.Methods Retrospective analysis was made on the basic information,microbial culture of wound secretions and drug sensitivity results of 3743 patients with severed fingers admitted to our hospital from January 2018 to May 2022,and empirical treatment drug strategies were recommended in combination with relevant guidelines and consensus.Results A total of 1064 bacterial strains were detected in the wound secretion culture of these patients,754 of which were considered as pathogenic bacteria,including 425(56.4%)gram-negative(G-)bacteria,282(37.4%)gram-positive(G+)bacteria and 47(6.2%)fungi.The age of the patients was(47.0±12.5)years,and the maleto female ratio was 3:1.The collection time of wound secretion in the G+and G-bacteria detection groups was(3.82±2.19)hours and(4.54±3.55)hours,respectively,with statistical significance.The injury mechanism was machine wring,curling,etc.The detection rate of G-bacteria increased.The detected G-bacteria mainly include Enterobacter cloacae,Acinetobacter baumanni,Pseudomonas aeruginosa,etc.Amikacin,levofloxacin,piperacillin sodium tazobactam,ceftazidime,etc.can be empirically selected.The detected G+bacteria are mainly Staphylococcus,which can be empirically selected as fusidic acid,rifampicin,mupirocin,tetracycline,tobramycin,etc.,but it is not recommended to useβ-Lactam antibiotics.Conclusion For the empirical treatment of patients with finger amputation,in addition to the staphylococcus infection,for the wound secretion,which takes a long time to collect and is seriously injured,G-bacteria should also be covered,and appropriate drugs should be selected according to their drug resistance characteristics.

关 键 词：病原体 抗菌药 手指离断伤 经验性治疗 

分 类 号：R658.2[医药卫生—外科学]