地震伤患者创面鲍曼/溶血不动杆菌定植与感染的研究

摘要

Objective To investigate the clinical characteristics and therapeutic methods of bac-terial colonization and infection of Acinetobacter baumannii on the wound of earthquake induced patients. Methods A retrospective study was done on 42 Wenehuan earthquake induced patients with positive wound germiculture of Acinetobacter baumannii. There were 24 males and 18 females, at mean age of 37 years (12-96 years). Open injury was located at the upper arm in one patient, at the forearm in four, at the thigh in 12, at the calf in 23 and at the trunk in two. The time between injury and treatment varied from 3 to 7 days. The clinical characteristics including the bacteria identification and drug sensitivity test were studied to compare drug resistance to 15 antibiotics. Results Bacterial colonization of Acineto-bacter baumannii was found in 31 patients (8.2%) and infection of Acinetobacter baumannii in 11 (2.9%). After debridement, pruphylactic antibiotics and nutrition support, 15 patients with bacterial colonization were managed with Ⅱ stage suture or skin grafting. The other 16 patients were transferred to hospitals of other provinces after germiculture turned negative. Through debridement and drainage, antibi-otic therapy and nutrition support, the infection was controlled and the wound eliminated in six patients through Ⅱ stage suture but four were concomitant with pulmonary infection and one with septicemia. Drug sensitivity test showed that sensitive rate to imipenem, amikacin, levofloxacin, ticarcillin-clavulanic acid, tobramycin were 59.5%, 21.4%, 21.4%, 19.5% and 19.0% respectively. Conclusions The risk factors of infection of Acinetobacter baumannii include severe tissue trauma, severe wound contamination, delayed treatment and weak body resistance. During treatment, the bacterial colonization and infection of Acinetobacter baumannii should be distinguished and treated respectively. Correct wound treatment, suit-able antibiotic therapy and increased body resistance are key to improvement of clinical curative effect.%目的 研究地震伤患者创面鲍曼/溶血不动杆菌定植和感染的临床特点,探索其诊治对策. 方法 选择"5.12"汶川地震后收治的376例开放性损伤患者中42例创而鲍曼/溶血不动杆菌培养阳性患者进行回顾性分析,其中男24例,女18例;年龄12～96岁,平均37岁.开放性损伤部位:上臂1例,前臂4例,大腿12例,小腿23例,躯干2例.伤后到就诊入院时间3～7 d.了解其临床特点并做细菌鉴定和药物敏感试验,对比分析其对15种抗生素的耐药性. 结果 本组地震伤患者中创而鲍曼/溶血不动杆菌定植31例,发生率为8.2%;创面鲍曼/溶血不动杆菌感染11例,发生率为2.9%.经清创、早期预防性抗生素使用、营养支持,15例细菌定植患者均行Ⅱ期缝合或创面植皮,16例创面培养阴性后转外省治疗;经扩创引流、全身敏感抗生素使用、全身营养支持,11例感染患者中有6例创面感染控制,Ⅱ期消火创面,4例患者出现肺部感染,1例患者出现败血症.创面检出的42株鲍曼/溶血小动杆菌药敏结果 中,对亚胺硫霉素最为敏感,敏感率为59.5%;对丁胺卡那、左氧氟沙星、替卡西林/棒酸、妥布霉素较为敏感,敏感率分别为21.4%、21.4%、19.5%、19.0%. 结论 地震伤患者创丽鲍曼/溶血不动杆菌感染的危险因素有:组织创伤重、伤口污染重、伤后到获得初次救治间隔时间长、机体抵抗力弱.在诊疗上应注意区分细菌定植和细菌感染的不同临床特点,重视创面正确处理、抗生素合理使用和增加机体抵抗力,可提高临床治愈率.