开放性骨折患者清创前后创面病原学培养及耐药性
作者:
作者单位:

作者简介:

莫基浩

通讯作者:

中图分类号:

R181.3+2R274.1

基金项目:

河南省教育厅科学技术研究重点项目(13A360564)


Pathogenic culture and detection of antimicrobial resistance of pathogens before and after debridement in patients with open fractures
Author:
Affiliation:

Fund Project:

  • 摘要
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 文章评论
    摘要:

    目的了解开放性骨折患者伤口分泌物病原菌检出情况及其耐药性,以指导临床治疗。方法对某院2012年5月—2013年7月1 472例开放性骨折患者清创前后伤口分泌物标本进行病原菌培养和鉴定,以及药敏试验。结果清创前,1 472例患者的分泌物标本中,1 246例(84.65%)培养阳性,共检出病原菌2 246株,其中824例(55.98%)检出2种及以上菌株。实施清创术后8 h,195例(13.25%)患者标本培养阳性,检出病原菌201株。Gustilo 分型中,伤情越严重者病原培养阳性率越高。创面培养阳性率,清创前各分型患者均>50%;清创后,Ⅰ型、Ⅱ型与ⅢA型患者均<5%,而ⅢB和ⅢC型患者仍较高。金黄色葡萄球菌、表皮葡萄球菌对万古霉素敏感,对呋喃妥因耐药率<5%,对青霉素G、红霉素高度耐药(耐药率>75%);鲍曼不动杆菌对多种抗菌药物具有较强的耐药性,即使较为敏感的头孢哌酮/舒巴坦耐药率也达20%;铜绿假单胞菌对亚胺培南耐药率为10.80%,对头孢哌酮/舒巴坦、头孢吡肟、头孢他啶也较为敏感。结论对开放性骨折患者及时清创能明显减少创面病原菌;病原菌的药敏试验结果有助于指导临床合理用药。

    Abstract:

    ObjectiveTo realize the detection of pathogens and antimicrobial resistance of pathogens isolated from wound secretion in patients with open fractures, so as to guide clinical treatment.  Methods1 472 patients with open fractures from May 2012 to July 2013 were selected from a hospital, pathogens from wound secretions before and after debridement were identified and performed antimicrobial susceptibility testing. ResultsBefore debridement, 1 246 of 1 472 patients (84.65%) were isolated 2 246 bacterial strains, 824 (55.98%) of patients were isolated at least 2 kinds of bacteria. Eight  hours after  debridement, 201 pathogenic bacteria were isolated from 195 patients  (13.25%).  The more serious of  Gustilo type, the higher the positive rate of bacterial culture. Positive rate of wound culture were all >50% in patients of  all Gustilo types before debridement;positive rate were all <5% in patients of  type I,  Ⅱ and  ⅢA, but type ⅢB and  ⅢC were still high after debridement. Staphylococcus aureus and Staphylococcus epidermidis were sensitive to vancomycin, the resistant rates to furantoin were <5%, the resistant rates to penicillin G and erythromycin were all >75%. Acinetobacter baumannii had higher resistance to multiple antimicrobial agents, to cefoperazone / sulbactam was 20%; Pseudomonas aeruginosa to imipenem was 10.80%, sensitivity to cefoperazone / sulbactam,cefepime and ceftazidime  were all higher. ConclusionFor patients with open fractures, timely debridement can reduce wound pathogen, antimicrobial susceptibility testing result is helpful for guiding rational antimicrobial use.

    参考文献
    相似文献
引用本文

莫基浩,李少侠,尚秋美,等.开放性骨折患者清创前后创面病原学培养及耐药性[J]. 中国感染控制杂志,2014,13(10):588-591. DOI:10.3969/j. issn.1671-9638.2014.10.003.
MO Jihao, LI Shaoxia, SHANG Qiumei, et al. Pathogenic culture and detection of antimicrobial resistance of pathogens before and after debridement in patients with open fractures[J]. Chin J Infect Control, 2014,13(10):588-591. DOI:10.3969/j. issn.1671-9638.2014.10.003.

复制
分享
文章指标
  • 点击次数:
  • 下载次数:
  • HTML阅读次数:
  • 引用次数:
历史
  • 收稿日期:2014-04-18
  • 最后修改日期:2014-06-12
  • 录用日期:
  • 在线发布日期: 2014-10-30
  • 出版日期: