慢性感染性难愈合创面感染病原菌分布特征及耐药性分析  

Analysis of the Distribution Characteristics of Pathogens and Their Antimicrobial Resistance in Chronic Infectious Refractory Wounds

作　　者：唐玉莹 向丽萍[2] TANG Yuying;XIANG Liping(Hunan University of Chinese Medicine,Changsha,Hunan 410005,China;Department of TCM Surgery,The Second Affiliated Hospital of Hunan University of Chinese Medicine,Changsha,Hunan 410005,China)

机构地区：[1]湖南中医药大学,湖南长沙410005 [2]湖南中医药大学第二附属医院中医外科,湖南长沙410005

出　　处：《中国烧伤创疡杂志》2024年第2期95-100,共6页The Chinese Journal of Burns Wounds & Surface Ulcers

摘　　要：目的分析探讨慢性感染性难愈合创面感染病原菌分布特征及耐药性特点。方法选取2021年1月至2022年12月湖南中医药大学第二附属医院收治的142例慢性感染性难愈合创面患者作为研究对象,分析创面感染病原菌分布特征及其对抗菌药物的耐药情况。结果142例患者共分离出病原菌183株,其中革兰氏阴性菌120株(65.57%),主要以大肠埃希菌(15.30%)、铜绿假单胞菌(14.21%)为主;革兰氏阳性菌61株(33.34%),主要以金黄色葡萄球菌(19.13%)为主;真菌2株(1.09%),均为近平滑念珠菌。药物敏感试验结果显示,大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌对氨苄西林、头孢唑林、头孢呋辛等药物的耐药性均较高(≥60%),而大肠埃希菌对阿米卡星、呋喃妥因、替加环素等药物的耐药性均较低(<10%),铜绿假单胞菌对左氧氟沙星、阿米卡星、粘菌素等药物的耐药性均较低(<10%),鲍曼不动杆菌与肺炎克雷伯菌对替加环素、粘菌素等药物的耐药性均较低(<10%);奇异变形杆菌对米诺环素、替加环素、粘菌素完全耐药(100%),而对氨曲南、头孢他啶、庆大霉素等药物的耐药性均较低(<10%);金黄色葡萄球菌、表皮葡萄球菌对阿莫西林、氨苄西林、氨曲南等药物的耐药性均较高(≥60%),粪肠球菌对氨曲南、红霉素、克林霉素等药物的耐药性均较高(≥60%),而三者对万古霉素、达托霉素、利奈唑胺等药物均未产生耐药性(0%)。结论慢性感染性难愈合创面感染病原菌以大肠埃希菌、铜绿假单胞菌等革兰氏阴性菌及金黄色葡萄球菌等革兰氏阳性菌为主,且对抗菌药物耐药性不尽相同,临床医师应根据病原菌分布特征及药物敏感试验结果合理规范使用抗菌药物,以促进创面愈合。Objective To study the distribution characteristics of pathogens and their antimicrobial resistance in chronic infectious refractory wounds.Methods 142 patients with chronic infectious refractory wounds admitted into The Second Affiliated Hospital of Hunan University of Chinese Medicine between January 2021 and December 2022 were enrolled as research subjects to analyze the distribution characteristics of pathogens in infectious wounds and their resistance to anti-bacterial agents.Results A total of 183 strains of pathogens were isolated from the 142 patients.Among them,120 strains(6557%)were gram-negative bacteria,commonly being escherichia coli(1530%)and pseudomonas aeruginosa(1421%),61 strains(3334%)were gram-positive bacteria,commonly being staphylococcus aureus(1913%),and 2 strains were fungi(109%),all being candida parapsilosis.Drug sensitivity test showed that escherichia coli,pseudomonas aeruginosa,acinetobacter baumannii,klebsiella pneumoniae had high resistance to ampicillin,cefazolin,cefuroxime and other drugs(≥60%),while escherichia coli had low resistance to amikacin,nitrofurantoin,tigecycline and other drugs(<10%).Pseudomonas aeruginosa showed low resistance to levofloxacin,amikacin,colistin and other drugs(<10%).Acinetobacter baumannii and Klebsiella pneumoniae showed low resistance to tigecycline,colistin and other drugs(<10%).Proteus mirabilis was completely resistant to minocycline,tigecycline and colistin(100%),but had low resistance to aztre-onam,ceftazidime,gentamicin and other drugs(<10%).Staphylococcus aureus and staphylococcus epidermidis had much high resistance to amoxicillin,ampicillin,aztreonam and other drugs(≥60%).Enterococcus faecalis had much high resist-ance to aztreonam,erythromycin,clindamycin and other drugs(≥60%),while the three were not resistant to vancomycin,daptomycin,linezolid and other drugs(0%).Conclusion The pathogens in chronic infectious refractory wounds are mainly gram-negative bacteria such as escherichia coli and pseudomonas aeruginosa,and gram-positive bac

关 键 词：慢性难愈合创面 感染性创面 病原菌 抗菌药物 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R641[医药卫生—临床医学]