摘要
目的对严重烧伤血流感染患者病原菌分布、耐药性进行分析，为此类患者的临床治疗提供参考。方法收集笔者单位烧伤ICU2011年1月--2014年12月收治的162例严重烧伤（含特重度烧伤120例）血流感染患者的血液标本，采用全自动血培养仪进行病原菌培养，API细菌鉴定板条进行病原菌鉴定。采用K—B纸片扩散法检测主要革兰阴性菌、革兰阳性菌对氨苄西林、哌拉西林、替考拉宁等37种抗生素的耐药情况（万古霉素采用E试验检测），以及真菌对伏立康唑、两性霉素B等5种抗生素的耐药情况。采用改良Hodge试验进一步确认亚胺培南、美罗培南耐药肺炎克雷伯菌，采用D试验检测金黄色葡萄球菌对红霉素诱导克林霉素耐药情况。用WHONET5．5软件统计病原菌分布及常见病原菌耐药率、特重度烧伤患者和非特重度烧伤患者的病死率及感染病原菌种类。对数据行Wilcoxon秩和检验。结果（1）4年中共送检血液标本1658份，检出病原菌339株（20．4％），其中革兰阴性菌、革兰阳性菌、真菌的检出率分别为68．4％（232／339）、24．5％（83／339）、7．1％（24／339）。检出率居于前3位的病原菌从高到低依次为鲍氏不动杆菌、金黄色葡萄球菌和铜绿似单胞菌。（2）鲍氏不动杆菌除对米诺环素和多黏菌素B耐药率较低外，对其余抗生素耐药率均较高，为81．0％-100．0％。铜绿假单胞菌对多黏菌素B不耐药，对其余抗生素的耐药率为57．7％～100．0％。阴沟肠杆菌对亚胺培南、美罗培南不耐药，对环丙沙星、左氧氟沙星、头孢哌酮／舒巴坦、头孢吡肟、哌抟西林／他唑巴坦耐药率为25．0％～49．0％，对其余抗生素耐药率为66．7％～100．0％。肺炎克雷伯菌对头孢哌N／舒巴坦、亚胺培南、美罗培南耐药率低，为5．9％～15．6％（2株亚胺培南及美罗培南耐药株经改良Hodge试验进一
Objective To analyze the distribution and drug resistance of pathogen isolated from severely burned patients with bloodstream infection, so as to provide reference for the clinical treatment of these patients. Methods Blood samples of 162 severely burned patients （including 120 patients with extremely severe burn） with bloodstream infection admitted into our burn ICU from January 2011 to December 2014 were collected. Pathogens were cultured by fully automatic blood culture system, and API bacteria identification panels were used to identify pathogen. Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of major Gram-negative and -positive bacteria to 37 antibiotics including ampicillin, piperacillin and teicoplanin, etc. （resistance to vancomycin was detected by E test） , and drug resistance of fungi to 5 antibiotics including voriconazole and amphotericin B, etc. Modified Hodge test was used to further identify imipenem and meropenem resistant Klebsiella pneumonia. D test was used to detect erythromycin-induced clindamycin resistant Staphylococcus aureus. The pathogen distribution and drug resistance rate were analyzed by WHONET 5.5. Mortality rate and infected pathogens of patients with extremely severe burn and patients with non-extremely severe burn were recorded. Data were processed with Wilcoxon rank sum test. Results （1） Totally 1 658 blood samples were collected during the four years, and 339 （20.4%） strains of pathogens were isolated. The isolation rate of Gram-negative bacteria, Gram-positive bacteria, and fungi were 68.4% （232/339） , 24.5% （83/339） , and 7. 1% （24/339） , respectively. The top three pathogens with isolation rate from high to low were Acinetobacter baumannii , Staphylococcus aureus , and Pseudomonas aeruginosa in turn. （2） Except for the low drug resistance rate to polymyxin B and minocycline, drug resistance rate ofAcinetobacter baumannii to the other antibiotics were relatively high （81.0% - 100.0% ）. Pseudomonas aeruginosa
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2016年第9期529-535,共7页
Chinese Journal of Burns
基金
国家自然科学基金（81571896）
关键词
烧伤
感染
细菌
真菌
抗药性
Burns
Infection
Bacteria
Fungi
Drug resistance
