创伤性伤口分泌物中病原微生物的分布和耐药性分析  

Distribution and drug resistance analysis of pathogenic microorganisms in traumatic wound secretions

作　　者：蓝亮光 严平 黄有平 LAN Liang-guang;YAN Ping;HUANG You-ping(Department of Clinical Laboratory,Fuyang Orthopedics and Traumatology Hospital of Traditional Chinese Medicine,Hangzhou 311400,Zhejiang,CHINA;Department of Clinical Laboratory,Fuyang District First People's Hospital,Hangzhou 311400,Zhejiang,CHINA)

机构地区：[1]杭州市富阳中医骨伤医院检验科,浙江杭州311400 [2]杭州市富阳区第一人民医院检验科,浙江杭州311400

出　　处：《海南医学》2024年第18期2656-2660,共5页Hainan Medical Journal

基　　金：浙江省医药卫生科技项目(编号:2024KY1455)。

摘　　要：目的探究创伤性伤口分泌物中所检出的病原微生物分布和耐药性,为抗生素的合理使用提供参考数据。方法收集2021年1月至2023年6月杭州市富阳中医骨伤医院收治的1689例不同住院患者创伤性伤口分泌物中检出的病原菌1836株,使用VITEK-MS质谱仪和VITEK-2Compact全自动细菌鉴定药敏分析系统,结合K-B法进行细菌鉴定及药敏分析。结果共检出1836株病原菌,其中革兰氏阳性球菌1187株,占64.65%,革兰氏阴性杆菌504株,占27.45%,革兰氏阳性杆菌134株,占7.3%,真菌3株,占0.16%;革兰氏阳性球菌中金黄色葡萄球菌395株(21.51%),表皮葡萄球菌321株(17.48%),溶血葡萄球菌117株(6.37%),沃氏葡萄球菌102株(5.56%),人葡萄球菌人亚种36株(1.96%)。革兰氏阳性杆菌以蜡样芽孢杆菌为主有113株(6.15%),而革兰氏阴性杆菌中铜绿假单胞菌147株(8.01%),大肠埃希菌102株(5.56%),阴沟肠杆菌66株(3.59%),奇异变形杆菌24株(1.31%)。药敏试验结果显示,金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌对青霉素耐药性最强,未检出耐万古霉素、利奈唑胺、替加环素菌株,但MRSA的出现率较高,占比达35.69%;溶血葡萄球菌和表皮葡萄球菌对苯唑西林的耐药性较高。革兰氏阴性杆菌中大肠埃希菌的耐药性较强,未出现亚胺培南、美罗培南耐药的大肠埃希菌和阴沟肠杆菌;铜绿假单胞菌对碳青霉烯类抗生素普遍敏感。结论熟悉掌握创口感染主要病原菌的种类、分布特点及耐药情况,有利于临床相对精准地进行经验用药,指导促进抗生素的合理应用。Objective To explore the distribution and drug resistance of pathogenic microorganisms detected in traumatic wound secretions and provide reference for the rational use of antibiotics.Methods A total of 1836 pathogenic bacteria detected in 1689 samples of traumatic wound secretions of hospitalized patients at Fuyang Orthopedics and Traumatology Hospital of Traditional Chinese Medicine from January 2021 to June 2023 were collected.Bacterial identification and drug sensitivity analysis were performed using VITEKMS mass spectrometer and VITEK2 Compact automatic microbial identification and drug susceptibility system combined with the KB method.Results A total of 1836 pathogens were detected,including 1187 strains of Grampositive cocci(accounting for 64.65%),504 strains of Gramnegative bacilli(accounting for 27.45%),134 strains of Grampositive bacilli(accounting for 7.3%),and 3 strains of fungi(accounting for 0.16%).Among the Grampositive cocci,there were 395 strains of Staphylococcus aureus(21.51%),321 strains of Staphylococcus epidermidis(17.48%),117 strains of Staphylococcus haemolyticus(6.37%),102 strains of Staphylococcus worderi(5.56%),and 36 strains of Staphylococcus hominis subsp.hominis(1.96%).Grampositive bacilli were mainly Bacillus cereus(113 strains,6.15%),while Gramnegative bacilli were mainly Pseudomonas aeruginosa(147 strains,8.01%),Escherichia coli(102 strains,5.56%),Enterobacter cloacae(66 strains,3.59%),and Proteus mirabilis(24 strains,1.31%).The results of drug sensitivity tests showed that Staphylococcus aureus,Staphylococcus epidermidis,and Staphylococcus haemolyticus were the most resistant to penicillin.No strains were detected were resistant to vancomycin,linezolid,or tigecycline.However,methicillinresistant Staphylococcus aureus(MRSA)was detected,accounting for 35.69%.Staphylococcus aureus and Staphylococcus epidermidis were highly resistant to oxacillin.Among Gramnegative bacteria,Escherichia coli had strong drug resistance,and no imipenemresistant or meropenemresistant Escherichia coli and

关 键 词：伤口分泌物 病原微生物分布 耐药性 

分 类 号：R641[医药卫生—外科学]