摘要
目的探讨临床送检伤口分泌物培养病原菌的菌群分布特点及耐药性情况,为临床合理使用抗生素及控制医院感染提供科学依据。方法收集2016年1月—2019年1月笔者所在医院病房送检的662例伤口分泌物标本检验信息,对标本涂片镜检及病原菌分布特点、耐药性进行回顾性分析。结果共分离出304例阳性标本,阳性率为45.91%;其中革兰阴性杆菌占60.2%(183/304),以阴沟肠杆菌、铜绿假单胞菌、大肠埃希菌为主;革兰阳性球菌占38.2%(116/302),以金黄色葡萄球菌和凝固酶阴性葡萄球菌为主;真菌占1%(3/304)。革兰阳性球菌对万古霉素、利奈唑胺敏感率为100%,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为53.2%;革兰阴性杆菌中肠杆菌科细菌对阿米卡星、亚胺培南、美罗培南敏感率均达80%以上;肺炎克雷伯菌与大肠埃希菌产超广谱β-内酰胺酶(ESBLs)比例分别为58.33%和50%;铜绿假单胞菌对多黏菌素E敏感率均为100%,对替卡西林、替卡西林/克拉维酸耐药率最高均为48.39%;鲍曼不动杆菌多重耐药并且耐药率均较高。阳性标本的革兰染色镜检结果显示合格标本共107例(35.2%);查见细菌标本共计217例(71.4%);查见吞噬现象共计49例(16.1%)。结论伤口分泌物以金黄色葡萄球菌、阴沟肠杆菌、铜绿假单胞菌和大肠埃希菌为主要致病菌,大肠埃希菌中产ESBLs的比例较高,临床应依据病原菌药敏结果科学合理使用药物,防止抗生素滥用,减少产生耐药菌株的发生。同时证明涂片镜检在伤口分泌物培养中的必要性及作用。
Objective To understand the flora distribution and drug resistance characteristics of pathogens separated from wound secretion in order to provide references for clinical rational use of antibiotics and control of nosocomial infection.Methods The information of 662 specimens of wound secretions collected from the ward of author's hospital from January 2016 to January 2019 was collected.The distribution characteristics,drug resistance and microscopy of the specimens were retrospectively analyzed.Results A total of 302 positive samples were isolated,the positive rate was 45.61%;among them,Gram-negative bacilli accounted for 60.6%(183/302),mainly Enterobacter cloacae,Pseudomonas aeruginosa and Escherichia coli;Gram-positive cocci It accounted for 38.4%(116/302),mainly Staphylococcus aureus and coagulase-negative staphylococci;fungi accounted for 1%(3/302).The sensitivity rate of gram-positive cocci to vancomycin and linezolid was 100%,and the detected rate of methicillin-resistant Staphylococcus aureus(MRSA)was 53.2%.The sensitivity rate of enterobacter bacteria in Gram-negative bacillus to Amikacin,Meiluopeinan,and Amikacin reached above 90%;The ratio of extended-spectrumβ-lactamase(ESBLs)produced by Klebsiella pneumoniae and Escherichia coli was 58.33%and 50%,respectively.The sensitivity of Pseudomonas aeruginosa to polymyxin E was 100%.The highest resistance rates of ticarcillin and ticarcillin/clavulanic acid were 48.39%;Acinetobacter baumannii showed multiple drug resistance with a high resistance rate.The results of Gram staining microscopy of positive specimens showed a total of 107(35.2%)were qualified specimens;A total of 217(71.4%)specimens were detected bacteria;A total of 49 cases(16.1%)were found phagocytosis.Conclusion Staphylococcus aureus,Enterobacter cloacae,Pseudomonas aeruginosa and Escherichia coli were the main pathogenic bacteria in wound secretions.Escherichia coli produced a high proportion of ESBLs. Clinically,antibiotics should be chosen scientifically and rationally according to the drug
作者
蔡晓娜
江海洋
王鹏
韩永红
CAI Xiao-na;JANG Hai-yang;WANG Peng(Jiangsu College of Nursing,Huaian,Jiangsu 22300,China)
出处
《实用医药杂志》
2019年第11期967-970,984,共5页
Practical Journal of Medicine & Pharmacy
关键词
伤口分泌物
菌群分布
耐药性
Wound secretion
Flora distribution
Drug resistance
