【作者】 华明； 郑倩玲； 曹丹燕； 何振锋； 张碧珠； 郑刚； 黄永顺；

【Author】 HUA Ming;ZHENG Qian-ling;CAO Dan-yan;HE Zhen-feng;ZHANG Bi-zhu;ZHENG Gang;HUANG Yong-shun;Institute of Occupational Health Surveillance,Guangdong Province Hospital for Occupational Diseases Prevention and Treatment;Guangdong Provincial Key Laboratory of Occupational Diseases Prevention and Treatment;

【机构】 广东省职业病防治院职业健康监护所,广东省职业病防治重点实验室；

【摘要】 目的分析职业性三氯乙烯药疹样皮炎(0MDT)患者医院感染的临床特点和耐药性,指导临床合理治疗。方法收集1997年1月至2011年12月本院收治的186例0MDT患者的临床资料,对医院感染发生情况、病原菌分布与药敏试验结果进行回顾性分析。结果①186例患者中31例发生医院感染,感染率为16.7%(31/186)。②477份送检标本共检出病原菌131株,检出阳性率27.5%。革兰氏阳性(G~+)球菌是主要致病菌(50.4%),革兰氏阴性(G~-)杆菌、真菌各占27.5%、22.1%。金黄色葡萄球菌为优势菌(3 2.8%)。③离体药敏试验显示,G~+球菌与G~-杆菌对于青霉素类、头孢菌素类(第1、2代)、氨基糖苷类、大环内酯类、四环素类、喹诺酮类抗菌药物多数处于中介、高度耐药或者全耐药状态,出现对万古霉素、亚胺培南的耐药G~+球菌菌株。G~+球菌如金黄色葡萄球菌对万古霉素的敏感率均高于亚胺培南(P<0.001),G~-杆菌对亚胺培南、头孢他啶、头孢噻肟、头孢三嗪敏感性较高。结论 OMDT患者容易并发医院感染,耐药率高,应制定抗菌药物临床应用管理规范,规范进行耐药性监测,指导临床合理用药。更多还原

【Abstract】 Objective To investigate and analyze the clinical feature of nosocomial infection and drug resistance in patients with occupational medicamentosa-like dermatitis due to trichloroethylene(OMDT).Methods The clinical data of 186 cases of OMDT from January 1997 to December 2011 were collected.The incidence rate of nosocomial infection,pathogenic bacteria distribution and drug susceptibility test results were investigated and analyzed retrospectively.Results Among the 186 patients,31 cases occurred nosocomial infection with the infection rate 16.7%(31/186).The positive detection rate of pathogenic bacteria was 27.5%(131/477).Gram-positive cocci was the main pathogenic bacteria which occupied 50.4%(66/131).Gram-negative bacilli and fungi accounted for 27.5%(36/131) and 22.1%(29/131) respectively.Staphylococcus aureus(s.aureus)were the predominant bacterias which accounted for 32.8%(43/131).The antibiotic susceptibility profile showed that most Gram-positive cocci and Gram-negative bacilli were in drug-intermediate,higher drug-resistant or totally drug-resistant for the antimicrobial agents of penicillin,the first/second generation cephalosporin,aminoglycoside,large ring lactone,tetracycline,quinolone respectively.The drug-resistant strains to vancomycin and imipenem appeared among Gram-positive cocci.The sensitivity rate of vancomycin in Gram-positive cocci such as s.aureus strains were higher than that of imipenem(P <0.001).The susceptible rate of Gram-negative bacilli to imipenem,ceftazidime,cefotaxime and cefazolin triazine was higher.Conclusion OMDT patients are easily complicated with nosocomial infection and the drug resistance are severe.Clinical application management standards for antibacterial agents should be established to standardize the drug resistance monitoring and to guide the clinical ration drug use.更多还原