慢性感染性创面93例病原菌分布特点及耐药性分析

摘要

目的：了解慢性感染性创面患者病原菌分布特点及其耐药性，为临床治疗提供指导。方法回顾性分析2009年1月—2014年1月93例慢性感染性创面患者的临床资料，并对其创面处分离的135株病原菌分布及耐药性进行分析。结果93例慢性感染性创面患者共分离病原菌135株，包括革兰阳性菌（G+）64株，占47.41%，革兰阴性菌（G-）55株，占40.74%，真菌16株，占11.85%。 G+菌以金黄色葡萄球菌为主，其次为溶血葡萄球菌、粪肠球菌，葡萄球菌属对青霉素、红霉素、四环素耐药率较高，而对奎奴普汀、利奈唑胺、万古霉素、替加霉素较为敏感；G-菌以大肠埃希菌、铜绿假单胞菌、普通变形杆菌为主，肠杆菌属对头孢吡肟、哌拉西林/他唑巴坦、亚胺培南、厄他培南及美罗培南较为敏感。真菌以白色假丝酵母菌、热带假丝酵母菌，平滑假丝酵母菌为主。结论慢性感染性创面患者病原菌G+菌和G-菌感染比例相近，但耐药形势严峻，多重耐药性明显。%ObjectiveTo understand pathogenic bacteria distribution features and drug resistance of patients with chronic infectious wounds,to provide guidance for clinical treatment.MethodsReviewed and analyzed clinical records of 93 patients with chronic infectious wounds from January 2009-January 2014,and analyzed distribution and drug resistance of 135 strains of pathogenic bacteria,what are separated from the wounds.Results93 patients with chronic infectious wounds separate from 135 strains pathogenic bacteria,including 64 strains gram-positive bacterium (G+),accounting for 44.71%,55 strains gram-negative bacterium(G-),accounting for 40.74% and 16 strains fungus, accounting for 11.85%. G+ bacterium is given priority to with staphylococcus aureus,followed by hemolysis staphylococcus and dung enterococcus,staphylococcus has higher drug-resistance to cefazolin,penicillin and erythromycin,but is sensitive to Quinupristin,linezolid,vancomycin and Tigemycin;G- bacterium is given priority to with E. coli,P. aeruginosa and Bacillus proteus vulgaris. Enterobacter is sensitive to cefepime,piperacillin / tazobactam, imipenem,ertapenem and meropenem,and has different degree of drug resistance to other antimicrobial agents. Fungus is given priority to with white candida,tropical candida and smooth candida.ConclusionThe proportion of G+ bacterium and G- bacterium among patients with chronic infectious wounds is similar,the antimicrobial activity of linezolid,vancomycin,imipenem and cefepime is higher,but resistance situation is serious and multiple drug-resistance is obvious.