文章摘要

邢台地区某骨科医院骨科患者主要病原菌分布及耐药性分析

作者: 1何素瑞, 1袁英泽, 1宋倩, 1张令博, 1王俊召, 1耿琳
1 邢台矿业集团总医院检验科,河北 邢台 054000
通讯: 何素瑞 Email: hesurui@163.com
DOI: 10.3978/j.issn.2095-6959.2021.03.007

摘要

目的:探讨邢台地区邢台矿业集团总医院2018至2019年骨科患者主要病原菌分布及耐药性分析,并分析其危险因素,为患者抗菌药物使用提供指导。方法:选取邢台地区2018年1月至2019年12月650例骨科患者作为研究对象。对所有患者进行细菌感染标本分离培养、鉴定并进行药物敏感试验。分析主要病原菌分布特点、耐药性特征,并用logistic回归分析邢台地区骨科患者细菌感染的危险因素。结果:对采集到的标本进行培养,从分泌物中分离出536株病原菌,占比79.88%,从尿液中分离出47株病原菌,占比7.0%,从痰液中分离出46株病原菌,占比6.86%,从咽拭子中分离出33株病原菌,占比4.92%,从血液中分离出9株病原菌,占比1.34%;共分离出671株病原菌菌株,其中金黄色葡萄球菌200株(29.81%),阴沟肠杆菌107株(15.95%),铜绿假单胞菌96株(14.31%),肺炎克雷伯菌88株(13.11%),大肠埃希菌86株(12.82%),鲍曼不动杆菌39株(5.81%),奇异变形杆菌28株(4.17%),表皮葡萄球菌15株(2.24%),嗜麦芽窄食单胞菌12株(1.79%)。药敏结果显示:金黄色葡萄球菌对红霉素、阿奇霉素及克林霉素耐药率较高,分别为76.7%、76.7%、75.2%,对万古霉素、替考拉宁及利奈唑胺耐药率均为0;阴沟肠杆菌耐药率最高的抗菌药物为头孢噻肟24.3%,其余抗菌药物的耐药率均低于20%;铜绿假单胞菌对亚胺培南、美罗培南及阿米卡星耐药率分别仅为2.9%、2.8%、0.3%;肺炎克雷伯菌对亚胺培南、美罗培南及阿米卡星耐药率为0。经logistic回归分析发现:手术时间>3 h、不良生活习惯、预防感染不合理用药是骨科患者术后伤口发生感染的危险因素。结论:对邢台地区骨科患者进行细菌感染流行病学特征及耐药性分析具有重要的临床诊治意义,能及时指导医生对导致患者手术伤口感染的危险因素进行预防并采取有效抗感染治疗。
关键词: 邢台地区;骨科患者;手术伤口感染;病原菌;耐药性

Epidemiological characteristics and drug resistance of bacterial infection in orthopaedic patients in Xingtai area

Authors: 1HE Surui, 1YUAN Yingze, 1SONG Qian, 1ZHANG Lingbo, 1WANG Junzhao, 1GENG Lin
1 Clinical Laboratory, Xingtai Mining Group General Hospital, Xingtai Hebei 054000, China

CorrespondingAuthor: HE Surui Email: hesurui@163.com

Abstract

Objective: To explore the epidemiological characteristics and drug resistance of bacterial infection in orthopaedic patients in Xingtai area from 2018 to 2019, and to analyze the risk factors, so as to provide guidance for the diagnosis and treatment of patients. Methods: A total of 650 orthopaedic patients in Xingtai region from January 2018 to December 2019 were selected as study subjects. Bacterial infection specimens were isolated, cultured, identified and tested for drug sensitivity in all patients. The distribution characteristics and drug resistance characteristics of major pathogenic bacteria were analyzed, and the risk factors of bacterial infection in orthopaedic patients in Xingtai area in recent two years were analyzed by logistic regression. Results: Among them, 536 strains (79.88%) were isolated from secretion, 47 strains (7.0%) were isolated from urine, 46 strains (6.86%) were isolated from sputum, 33 strains (4.92%) were isolated from throat swab, and 9 strains (1.34%) were isolated from blood There were 200 strains of Staphylococcus aureus (29.81%), 107 strains of Enterobacter cloacae (15.95%), 96 strains of Pseudomonas aeruginosa (14.31%), 88 strains of Klebsiella pneumoniae (13.11%), 86 strains of Escherichia coli (12.82%), 39 strains of Acinetobacter baumannii (5.81%), 28 strains of Proteus mirabilis (4.17%), 15 strains of Staphylococcus epidermidis (2.24%) and 12 strains of Stenotrophomonas maltophilia (1.79%). The drug sensitivity results showed that the drug resistance rates of Staphylococcus aureus to erythromycin, azithromycin and clindamycin were 76.7%, 76.7% and 75.2%, respectively, and the drug resistance rates of vancomycin, teicoplanin and linezolid were all 0; cefotaxime was 24.3% with the highest drug resistance rate, and the drug resistance rate of other antibiotics was less than 20%; Pseudomonas aeruginosa was resistant to imipenem, meropenem and amikacin 2.9%, 2.8%, 0.3% respectively; the drug resistance rates of Klebsiella pneumoniae to imipenem, meropenem and amikacin were 0; logistic analysis found that patients’ operation time was longer than 3 hours, bad living habits, and unreasonable drug use to prevent infection were risk factors for postoperative wound infection in orthopaedic patients. Conclusion: The epidemiological characteristics and drug resistance analysis of bacterial infection in orthopaedic patients in Xingtai area is of great significance for clinical diagnosis and treatment, which can timely guide doctors to prevent the risk factors that lead to surgical wound infection in patients and take effective anti-infection treatment.
Keywords: Xingtai area; orthopedic patients; infected surgical wound; pathogenic bacteria; drug resistance