摘要
目的 提供近年烧伤患者病原菌分布及耐药性状况的流行病学资料，以指导临床合理使用抗生素。 方法选择2003年3月-2011年6月西南医院全军烧伤研究所478例患者1977份临床标本（血液、导管、创面分泌物等），共分离出病原菌2748株。用API细菌鉴定板条鉴定菌株；采用K-B纸片扩散法，选择庆大霉素、妥布霉素、哌拉西林、阿米卡星等55种常用抗生素进行药物敏感试验。采用WHONET 5.3软件统计分析如下项目：各年度不同类型、不同标本来源的病原菌分布情况，主要革兰阴性杆菌、革兰阳性球菌、真菌对多种抗生素的耐药率变化情况，铜绿假单胞菌、金黄色葡萄球菌、鲍氏不动杆菌、白色念珠菌对多种抗生素的敏感率变化情况。 结果2748株病原菌中，革兰阴性杆菌1879株占68. 38%、革兰阳性球菌628株占22. 85%、真菌241株占8.77%。创面分泌物标本病原菌检出率最高（1022株占37. 19%），其次是呼吸道（995株占36. 210/0）和血液（421株占15. 32%），其他类型标本检出率较低。铜绿假单胞菌检出率最高，共996株占36. 24%，其次是金黄色葡萄球菌和鲍氏不动杆菌，依次为495株占18. 01%，395株占14. 37%。鲍氏不动杆菌检出率呈逐年增加趋势，金黄色葡萄球菌呈逐年下降趋势，铜绿假单胞菌检出率较稳定。检出的葡萄球菌中以甲氧西林耐药金黄色葡萄球菌为主，共484株占17. 61%。铜绿假单胞菌和鲍氏不动杆菌对多黏菌素E、多黏菌素B的耐药率低于30. 00%，鲍氏不动杆菌对米诺环素的耐药率仅为39. 68%，除此之外，这2种细菌对其他抗生素如第三代头孢菌素、B内酰胺类、氨基糖苷类、喹诺酮类等抗生素呈多药耐药，耐药率为57. 910/0-100. 00%。2004-2011年，铜绿假单胞菌对喹诺酮类抗生素敏感率呈逐年增加趋势，鲍氏不动杆菌对米诺环素、奈替米星、亚胺培南、美罗培南、妥布霉素和头孢哌酮／舒巴坦敏感率呈逐年下降趋势。粪肠球菌、屎肠球菌和金黄色葡萄球菌对替考拉宁和利奈唑胺的耐药率低于10.00%。金黄色葡萄球菌、表皮葡萄球菌和屎肠球菌对万古霉素的耐药率均为O。金黄色葡萄球菌对奎奴普丁／达福普汀、米诺环素、夫西地酸和复方磺胺甲嗯唑的耐药率较低，分别为0.82%、9. 35%、2.21c70和31. 85c70；该菌对红霉素、克林霉素、复方磺胺甲呱唑、四环素和米诺环素的敏感率呈还年增加趋势。真菌感染率很低，且对药物的耐药率不高；白色念珠菌对5种抗生素的耐药率均低于15. 00%，除对5-氟胞嘧啶的敏感率略呈下降趋势外，对其他4种抗生素的敏感率均呈逐年上升趋势。 结论 近年引发西南医院烧伤研究所患者感染的病原菌中，居前3位的依次为铜绿假单胞菌、金黄色葡萄球菌和鲍氏不动杆菌。所有分离菌株中铜绿假单胞菌和鲍氏不动杆菌的多药耐药性尤为突出，鲍氏不动杆菌将可能取代铜绿假单胞菌成为烧伤感染死亡的主要致病菌。
Objective To provide epidemiological data of the distribution characteristics and drug resistance of the pathogens isolated from burn patients in recent years for guiding rational use of antibiotics in clinic. Methods Totally 2748 strains of pathogens were isolated from 1977 specimens （blood, catheter, wound excretion, etc. ） collected from 478 patients hospitalized in Institute of Burn Research of Southwest Hospital from March 2003 to June 2011. After being identified by API strips, drug resistance of the 2748 isolated pathogens to 55 commonly-used antibiotics including gentamicin, tobramycin, piperacillin, amikacin, etc. was tested by K-B paper disk diffusion method. The WHONET 5.3 software was used to analyze the following subjects： the distribution of the pathogens with different types and different sources each year, the changes in drug-resistant rates of Gram negative bracilli, Gram positive cocci, and fungi to several antibiotics, and the changes in sensitive rates ofPseudomonas aeruginosa （PA） , Staphylococcus aureus （SA） , Acinetobacter baumannii （AB） , Candida albicans （CA） to several antibiotics. Results Among 2748 strains of pathogens, 1879 strains of Gram negative bacilli accounted for 68.38% , 628 strains of Gram posi- tive cocci accounted for 22. 85% , and 241 strains of fungi accounted for 8.77%. The isolation rate of strains from wound excretion ranked the first （ 1022 strains accounted for 37.19% ） , followed by those from respiratory tract （995 strains accounted for 36.21% ） and blood （421 strains accounted for 15. 32% ）. Strains isolated from other types of specimens were rare. Isolation rate of PA ranked the first （996 strains accounted for 36.24% ） , followed by SA （495 strains accounted for 18.01% ） and AB （395 strains accounted for 14.37% ）. Isolation rate of AB showed a trend of increase year by year, but that of SA presented the opposite trend. Isolation rate of PA was quite stable. There were 484 strains of methicillin resistant SA among Staphylococci , accounting for 17.61%. Resistant rates of PA and AB to polymyxin B and polymyxin E were below 30.00% , and those of PA and AB to other antibiotics, such as the third generation cephalosporins, β-lactams, aminoglycosides, and quinolones, were from 57.91% to 100.00%. Resistant rate of AB to minocycline was 39.68%. From 2004 to 2011, sensitive rate of PA to quinolone antibiotics showed an increasing trend year by year, but that of AB to minocycline, netilmiein, imipenem, meropenem, tobramyein, and cefoperazone/sulbactam presented the opposite trend. Resistant rates of Enterococcous faecalis, Enterococcus faecium , and SA to teicoplanin and linezolid were less than 10.00%. Resistant rate of SA, Staphylococcus epidermidis and Enterococcus faecium to vancomycin was 0. Resistant rates of SA to quinu- pristin/dalfopristin, minocycline, fusidic acid, and compound sulfamethoxazole were low, respectively 0.82% , 9.35% , 2.21% , and 31.85%. Sensitive rates of SA to erythromycin, clindamycin, compound sulfamethoxazole, tetracycline, and minocycline showed an increasing trend year by year. Both infection rate and resistant rate of fungi were low. The resistant rates of CA to 5 kinds of antibiotics were less than 15.00%. The sensitive rate of CA to 5-flucytosine declined slightly, and those of CA to the other 4 antibiot- ics showed an increasing trend year by year. Conclusions The three dominant pathogens that cause infection in burn patients hospitalized in Institute of Burn Research of Southwest Hospital in recent years are PA, SA, and AB in order. PA and AB are outstandingly multidrug-resistant among the isolated strains. AB might replace PA as the main pathogenic bacterium that cause the death of burn patients with infection.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2012年第2期87-95,共9页
Chinese Journal of Burns
基金
国家科技支撑计划（2009BA187B03）
关键词
烧伤
感染
抗药性
流行病学
病原菌
Burns
Infection
Drug resistance
Epidemiology
Pathogen
