摘要
目的了解本地区烧伤科患者创面分泌物培养分离菌分布及常见细菌耐药情况。方法回顾性分析某三甲医院2021年—2023年烧伤科送检的创面分泌物分离菌分布,采用基质辅助激光解析时间飞行质谱仪对菌株进行鉴定,全自动细菌药敏系统对金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌进行抗菌药物敏感性检测。结果2021年—2023年共送检创面分泌物培养标本2817份,656份标本培养无细菌真菌生长,其余2161份标本分离到菌株2444株。分离的菌株中革兰阳性球菌1010株,革兰阴性杆菌960株,革兰阳性杆菌152株,真菌322株。构成前3位的细菌依次为金黄色葡萄球菌(17.02%)、大肠埃希菌(9.66%)和铜绿假单胞菌(8.80%)。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)检出率为28.9%,对青霉素G高度耐药(耐药率为91.8%),对红霉素耐药率为61.6%,对克林霉素耐药率为59.7%,未检出对万古霉素、替加环素、利奈唑胺和奎奴普丁/达福普汀耐药的菌株。大肠埃希菌对碳青霉烯类抗菌药物耐药率为2.7%,产超广谱β-内酰胺酶(ESBLs)检出率为67.6%,对喹诺酮类药物耐药率为62.8%~65.5%。铜绿假单胞菌对碳青霉烯类抗菌药物耐药率为7.6%,对氨基糖苷类药物、头孢他啶、头孢吡肟、环丙沙星和左氧氟沙星的耐药率均小于20%。结论烧伤科创面分泌物培养分离菌株种类多,分离的细菌对多种抗菌药物耐药严重,临床科室应重视标本的采集和送检,为抗菌药物合理使用提供病原学支撑。
Objective To investigate the distribution and drug resistance of isolated bacteria on wound secretion culture of burn department.Methods Distribution of isolated bacteria in wound exudates of a hospital from 2021 to 2023 was retrospectively analyzed.Matrix-assisted laser desorption time of flight mass spectrometry was used to identify the strains,and the antibiotic sensitivity of Staphylococcus aureus,Escherichia coli,Pseudomonas aeruginosa,and Acinetobacter baumannii was determined using an automatic bacterial drug sensitivity system.Results From 2021 to 2023,a total of 2817 wound exudates were cultured,656 samples were cultured without bacteria or fungi,and 2444 strains were isolated from the remaining 2161 samples.Included 1010 gram-positive cocci,960 Gramnegative bacilli,152 gram-positive bacilli and 322 fungi.The top three bacteria were Staphylococcus aureus(17.02%),Escherichia coli(9.66%),and Pseudomonas aeruginosa(8.80%).The rate of methicillin-resistant Staphylococcus aureus(MRSA)was 28.9%,the resistance rate to penicillin G was 91.8%,61.6%to erythromycin and 59.7%to clindamycin.No strains resistant to vancomycin,tigecycline,linezolid,quinupristin/dalfopristin were detected.The resistance rate of Escherichia coli to carbapenems was 2.7%,the extended spectrum beta-lactamase(ESBLs)rate was 67.6%,and the resistance rate to quinolones was 62.8%~65.5%.The resistance rate of Pseudomonas aeruginosa to carbapenems was 7.6%,and the resistance rate to aminoglycosides,ceftazidime,cefepime,ciprofloxacin,levofloxacin were less than 20%.Conclusion Numerous kinds of bacteria were identified from the burn department's wound exudate culture,and these bacteria showed significant resistance to a range of antibacterial medications.Clinical departments should pay attention to the collection and submission of specimens to provide etiological support for the rational use of antibiotics.
作者
龙小平
Long Xiao-ping(Department of Laboratory Medicine,Zigong Fourth People’s Hospital,Zigong Sichuan 643000)
关键词
烧伤科
分离菌株
耐药性
抗菌药物
病原菌构成
合理使用
burn department
isolated bacteria
drug resistance
antibacterial drugs
pathogen distribution
rational use
