【摘要】 目的分析2014-2018年骨科患者伤口分泌物病原菌分布及耐药特点,为临床合理使用抗菌药物提供依据。方法收集2014-2018年骨科分泌物培养阳性菌株687株;采用全自动微生物分析仪进行菌株鉴定及药敏试验,头孢哌酮/舒巴坦药敏试验采用K-B纸片扩散法;采用WHONET5.6软件对药敏结果进行统计分析,数据分析处理使用SPSS19.0软件。结果革兰阳性菌占50.36%,主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌;革兰阴性菌占48.18%,主要为大肠埃希菌、铜绿假单胞菌;金黄色葡萄球菌、凝固酶阴性葡萄球菌对万古霉素、利奈唑胺、替加环素耐药率均为0,对青霉素G、红霉素、克林霉素、四环素、复方磺胺甲噁唑、莫西沙星耐药率呈上升趋势(P<0.05);大肠埃希菌对亚胺培南、厄他培南耐药率为0,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率较低;对头孢吡肟、头孢他啶耐药率呈下降趋势(P<0.05);铜绿假单胞菌对头孢唑林、氨苄西林/舒巴坦、复方磺胺甲噁唑、四环素耐药率均为100%,对头孢吡肟、头孢他啶耐药率呈下降趋势(P<0.05);多重耐药菌的总检出率为24.02%,其中MRSA检出率为23.11%,CRPA检出率为27.27%,CRAB检出率为23.81%。结论骨科分泌物病原菌种类复杂,多重耐药菌检出率呈上升趋势,临床用药时要注意其耐药性,针对不同的病原菌采用不同的用药方案,减少耐药株在院内传播。更多还原

【Abstract】 Objective The pathogenic bacteria distribution and drug resistance characteristics of wound secretions in orthopedics patients from 2014 to 2018 were analyzed to provide a basis for the rational use of antibiotics in clinical practice.Methods From 2014 to 2018,687 positive strains of orthopedic secretions were collected and cultured.The strain identification and drug susceptibility test were conducted by automatic microbiological analyzer,the drug susceptibility test of cefoperazone/sulbactam was conducted by K-B disk diffusion method;WHONET5.6 software was used for statistical analysis of drug susceptibility results and SPSS19.0 was used for data processing.Results Gram-positive bacteria accounted for 50.36%,mainly Staphylococcus aureus and coagulase negative Staphylococcus;Gram-negative bacteria accounted for 48.18%,mainly Escherichia coli and Pseudomonas aeruginosa;The drug resistance rates of Staphylococcus aureus and coagulase negative Staphylococcus to vancomycin,linezolid and tigaricycline were 0,the drug resistance rate of penicillin G,erythromycin,clindamycin,tetracycline,compound SMZco and moxifloxacin showed an increasing trend(P<0.05);The drug resistance rate of Escherichia coli to imipenem and ethapenem was 0,and the drug resistance rate to cefoperazone/sulbactam,piperacillin/tazobactam was lower;The drug resistance rate of cefepime and ceftazidine showed a decreasing trend(P<0.05).The drug resistance rates of pseudomonas aeruginosa to cefazolin,ampicillin/sulbactam,SMZco and tetracycline were all 100%,and the drug resistance rates to cefepime and ceftazidine showed a decreasing trend(P<0.05);The total detection rate of multi-drug resistant bacteria was 24.02%,including 23.11%for MRSA,27.27%for CRPA and 23.81%for CRAB.Conclusion The types of pathogenic bacteria in orthopaedic secretions are complex,and the detection rate of multi-drug resistant bacteria is on the rise.Therefore,we should pay attention to their drug resistance in clinical medication,and adopt different drug regimens for different pathogenic bacteria to reduce the spread of drug-resistant strains in hospitals.更多还原