69例坏死性筋膜炎患者的病原菌分布与细菌耐药性分析  

Pathogen distribution and antibiotic resistance analysis of 69 cases of necrotizing fasciitis

作　　者：陈英斌 黄银涛 首家保 宋蕊 CHEN Yingbin;HUANG Yintao;SHOU Jiabao;SONG Rui(Department of Trauma Repair and Burn Plastic Surgery,Liuzhou Workers’Hospital,Liuzhou 545005,Guangxi,China;Department of Emergency Medicine,Liuzhou Workers’Hospital,Liuzhou 545005,Guangxi,China)

机构地区：[1]柳州市工人医院创伤修复烧伤整形外科,广西柳州545005 [2]柳州市工人医院急诊医学科,广西柳州5450051

出　　处：《中国现代医生》2025年第6期60-64,共5页China Modern Doctor

基　　金：广西壮族自治区卫生健康委员会自筹课题(Z20191105)。

摘　　要：目的 总结69例坏死性筋膜炎(necrotizing fasciitis,NF)患者的病原菌分布及药敏特征,为临床早期抗感染治疗提供证据支持。方法 回顾性分析2017年1月至2023年12月柳州市工人医院创伤修复烧伤整形外科收治的69例NF患者微生物培养和药敏试验结果。结果 共培养出77株细菌,其中革兰阳性菌24株,革兰阴性菌48株,真菌5株。单一微生物感染为主,占66.07%。革兰阳性菌株以金黄色葡萄球菌(10株,12.99%)、化脓性链球菌(5株,6.49%)多见,革兰阴性菌株以肺炎克雷伯菌(13株,16.88%)、大肠埃希菌(10株,12.99%)为主。多重耐药菌18株,占总菌株的23.38%。革兰阳性菌对万古霉素、利奈唑胺、替加环素等更敏感,而革兰阴性菌对美罗培南、头孢西汀、厄他培南更敏感。结论 本研究中肺炎克雷伯菌是NF最常见的致病菌,初始抗感染方案推荐使用万古霉素联合美罗培南,可更大程度提高抗感染效果。Objective To summarize the pathogen distribution and antibiotic resistance characteristics of 69 cases of necrotizing fasciitis(NF),providing evidence to support early clinical antimicrobial therapy.Methods A retrospective analysis was conducted on microbial culture and antibiotic susceptibility test results from 69 NF cases treated in the Department of Trauma Repair and Burn Plastic Surgery,Liuzhou Workers’Hospital from January 2017 to December 2023.Results A total of 77 bacterial strains were cultured,including 24 Gram-positive bacteria,48 Gram-negative bacteria,and 5 fungi.Monomicrobial infection was predominant,accounting for 66.07%of the cases.Among the Gram-positive bacteria,Staphylococcus aureus was the most common,separated out 10 strains(12.99%),followed by Streptococcus pyogenes in 5 strains(6.49%).Among the Gram-negative bacteria,Klebsiella pneumoniae(13 strains,16.88%)and Escherichia coli(10 strains,12.99%)were most frequently identified.A total of 18 multidrug-resistant strains were found,representing 23.38%of all isolates.Gram-positive bacteria were most sensitive to vancomycin,linezolid,and tigecycline,while Gram-negative bacteria showed the greatest sensitivity to meropenem,cefoperazone,and ertapenem.Conclusion In the study area,Klebsiella pneumoniae is the most common pathogen causing NF.The initial antimicrobial regimen should include vancomycin combined with meropenem,which may significantly enhance the effectiveness of infection control.

关 键 词：坏死性筋膜炎 病原菌分布 细菌耐药性 病原菌检测 抗生素 

分 类 号：R634[医药卫生—外科学]