摘要：
目的 探讨头面颈部烧伤患者枕芯污染病原菌的分布与耐药性,为临床合理用药及为患者提供更有效的护理提供参考.方法 便利抽样选取2014年12月至2016年12月辽宁中医药大学附属医院收治的93例烧伤患者使用的枕芯作为研究对象,每个枕芯定时定点采样,对其进行细菌定量和病原菌检测,并分析药物敏感性和耐药性.结果 共分离出病原菌993株,检出率50.84%.其中:革兰阴性菌720株,占比72.51%,主要为铜绿假单胞杆菌、大肠埃希菌和肺炎克雷伯氏菌;革兰阳性菌224株,占比22.56%,主要为表皮葡萄菌、微球菌属和金黄色葡萄球菌;真菌49例,占比4.93%.常见革兰阴性菌对替卡西林/克拉维酸的耐药率均>90.0%,对头孢吡肟、哌拉西林/他唑巴坦和呋喃妥因等耐药>50.0%;革兰阳性菌对青霉素G、甲氨西林的耐药率均>50.0%,对呋喃妥因、替加西林和万古霉素等耐药率均为0.结论 头颈部烧伤患者枕芯污染病原菌以革兰阴性菌为主,对临床常用抗菌药物均具有一定耐药性.因此,护理上应合理增加患者枕芯更换的频率和病房紫外线空气消毒机的消毒时间,严格执行消毒隔离及手卫生要求,以预防或减少枕芯污染情况.%Objective To evaluate the pathogenic bacteria distribution in the pillow and drug resistance of wound infection in head-neck burn patients,in order to provide effective reference for clinical medication and nursing.Methods By convenience sampling,93 pillow s used by head-neck burn patients treated in our hospital from December 2014 to December 2016 were enrolled to this study.Samples were taken from pil-lows at fixed time and location and quantative of bacteria was measured and pathogenic bacteria and were detected.Besides,the drug sensitivity test and drug resistance analysis were performed.Results 993 strains of bacteria were isolated,with the detection rate of 50.84%,in which 720 strains(72.51%)of gram-negative bacteria,mainly Pseudomonas aeruginosa,Escherichiacoli and Klebsiella pneumoniae.Besides, there were 224 strains(22.56%)of gram-positive bacteria,mainly Staphylococcus,Micrococcus and Staph-ylococcus aureus,and 49 strains(4.93%)of fungi.The drug resistance rate of common gram-positive bac-teria to takacillin /clavulanic acidcefepime,was above 90%,and more than 50% rate of resistance to pip-eracillin /tazobactam and furantoin.The drug resistance rate of common gram-negative bacteria to penicil-lin G and methicillin was above 50%,however,0% to furantoin,tegacillin and vancomycin.Conclusions The pathogenic bacteria in the pillow of head-neck burn patients are mainly gram-negative bacteria,which are resistant to common antibiltics to some extent.Therefore,there is a need to frequently change the pil-low,and increase the disinfection time of using UV air disinfection machine in the ward,strictly follow the rules of disinfection and isolation and hand hygiene requirement,in order to prevent and reduce the pillow contamination.
