上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2019, Vol. 39 ›› Issue (3): 292-.doi: 10.3969/j.issn.1674-8115.2019.03.013

• 论著·临床研究 • 上一篇    下一篇

烧伤患者感染病原菌的分布及耐药性分析

徐正鹏 1，王粟 2，糜琛蓉 3，韩立中 2，王文奎 1   

  1. 1. 上海交通大学医学院附属瑞金医院烧伤整形科，上海 200025；2. 上海交通大学医学院附属瑞金医院临床微生物科，上海 200025；3. 上海交通大学医学院附属瑞金医院医院感染管理科，上海 200025
  • 出版日期:2019-03-28 发布日期:2019-04-28
  • 通讯作者: 王文奎，电子信箱：wenkuiwang@hotmail.com。
  • 作者简介:徐正鹏（1965—），男，主治医师，学士；电子信箱： 13916854885@163.com。

Analysis of distribution and drug resistance of pathogens in burned patients

XU Zheng-peng1, WANG Su2, MI Chen-rong3, HAN Li-zhong2, WANG Wen-kui1   

  1. 1. Department of Burns and Plastic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 2. Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; 3. Department of Hospital Infection Control, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2019-03-28 Published:2019-04-28

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摘要： 目的 ·调查烧伤患者感染病原菌的种类及耐药性，为临床合理应用抗菌药物、减少耐药株产生及医院感染控制提供依据。方法 ·收集 2016年 1月— 2017年 12月上海交通大学医学院附属瑞金医院烧伤患者送检标本的分离菌株，采用 VITEK 2 Compact全自动微生物分析系统和 K-B纸片扩散法进行药敏试验，统计送检标本类型、菌种类型及主要致病菌的药敏结果。通过 χ2检验对比 2016—2017年与前期研究中 2013— 2014年主要病原菌的检出率及耐药率的变化。结果 ·共检出病原菌 1 053株，其中 73.88%为创面来源；检出革兰阴性杆菌 609株（57.83%）、革兰阳性球菌 422株（40.08%）、真菌 9株 (0.85%)。革兰阴性杆菌最常检出为肺炎克雷伯菌（ 218株，20.70%），显著高于 2013—2014年的检出率（ 114株，10.72%）（P0.000）；革兰阳性球菌最常检出为金黄色葡萄球菌（210株，19.94%），亦显著高于 2013—2014年的检出率（ 200株，18.81%）（P0.009）。肺炎克雷伯菌仅对哌拉西林 /他唑巴坦、头孢哌酮 /舒巴坦、亚胺培南、美罗培南、磷霉素和替加环素的耐药率低于 60%，对氨苄西林和头孢唑啉的耐药率则高于 90%，且对头孢他啶、头孢吡肟、亚胺培南、美罗培南和阿米卡星的耐药率明显高于 2013—2014年的统计结果（ P<0.05）。金黄色葡萄球菌对青霉素耐药率最高（ 94.63%），对万古霉素和利奈唑胺的敏感率为 100%。耐甲氧西林金黄色葡萄球菌检出率为 59.05%，与 2013— 2014年的检出率间差异无统计学意义（ P0.412）。结论 ·烧伤感染分离病原菌以肺炎克雷伯菌和金黄色葡萄球菌为主，且多重耐药性严重；管理干预及合理应用抗菌药物可控制耐药现象，及时定期监测患者病原菌的分布及耐药情况仍是控制预防院内感染的重要举措。

关键词: 烧伤, 病原菌, 流行病学, 耐药, 监测

Abstract:

Objective · To provide guidance for the rational usage of antibiotics, reduction of drug-resistant strains and hospital infection controlinvestigating the distribution and drug resistance of pathogens isolated burned patients. Methods · Isolates burned patients of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between Jan. 2016 and Dec. 2017 were collected. The VITEK 2 Compact automatic microbial analysis system and K-B disc diffusion method were used for antimicrobial susceptibility test. Statistical analysis was performed to investigate the type of specimens and strains and the resistance rates of major pathogens. Chi-square test was used to compare the changes of the detection rates and drug resistance rates of major pathogens between 2016-2017 and 2013-2014. Results · A total of 1 053 isolates were isolated, and most of them (73.88%) were wounds. Among them, 609 (57.83%) isolates were gram-negative bacilli (G-B), 422 (40.08%) were gram-positive cocci (G+C) and 9 (0.85%) were fungi. The most common pathogen of G-B was Klebsiella pneumoniae (218, 20.70%) in 2016-2017, the proportion of which was significantly higher than that in 2013-2014 (114, 10.72%) (P0.000). The most common pathogen of G+C was Staphylococcus aureus (210, 19.94%), the proportion of which was significantly higher than that in 2013-2014 (200, 18.81%) (P0.009). K. pneumoniae showed low resistance only to piperacillin/tazobactam, cefoperazone/sulbactam, imipenem, meropenem, fosfomycin and tigecycline (<60%), but high resistance to ampicillin and cefazolin (>90%). The resistance rates of K. pneumoniae to ceftazidime, cefepime, imipenem, meropenem and amikacin in 2016-2017 were significantly higher than those in 2013-2014 (P<0.05). S. aureus was only resistant highly to penicillin (94.63%) and 100% susceptible to vancomycin and linezolid. The proportion of methicillin-resistant S. aureus (MRSA) was 59.05% in 2016-2017, which had no statistical difference compared with that in 2013-2014 (P0.412). Conclusion · The most two prevalent isolates burned patients were K. pneumoniae and S. aureus with multi-drug resistance. Improved management and rational of antibiotics can reduce the incidence of antibiotic resistant pathogens, and it’s still important to keep routine surveillance on pathogens isolated burned patients for control and prevention of nosocomial infections.

Key words: burn, pathogen, epidemiology, resistance, surveillance

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