5·12汶川地震伤患者感染病原菌分布及药物敏感试验结果分析
|
摘要
目的分析5.12汶川地震伤患者感染病原菌的分布及抗菌药物敏感试验结果,为特大自然灾害抗感染治疗提供参考依据。方法收集2008年5～2008年7月地震伤患者送检各类样本中分离的非重复病原菌共441株。所有菌株以BD Phoenix100或VITEK32全自动微生物分析仪鉴定到种,药敏试验采用BD Phoenix100或VITEK32配套药敏试验复合板,药敏标准按2007年版CLSI/NCCLS规定执行。结果地震伤住院患者以伤口感染和呼吸道感染最常见,感染病原菌种类分布广,覆盖13个菌属,主要包括不动杆菌属、假单胞菌属、埃希菌属、肠杆菌属、葡萄球菌属等,感染病原菌中以多重耐药革兰阴性杆菌比革兰阳性球菌更为常见,并且合并2种甚至3种细菌的混合感染常见,混合感染率达60.6%。鲍曼不动杆菌耐药非常严重,除了有20%对亚胺培南和阿米卡星敏感,其余抗生素敏感率<12%;铜绿假单胞菌对氨基糖苷类(庆大霉素、阿米卡星、妥布霉毒)敏感率为80%;对哌拉西林、哌拉西林/他唑巴坦、头孢他啶敏感率为61.4%～73.9%,亚胺培南敏感率为48.6%,对其余抗生素敏感率<50%;大肠埃希菌对亚胺培南敏感率为100%,对哌拉西林/他唑巴坦敏感率为73.9%,对其余抗生素敏感率<35%;阴沟肠杆菌对亚胺培南敏感率为100%,对其余抗生素敏感率<30%。金黄色葡萄球菌对万古霉素、利奈唑胺敏感率为100%,对奎奴普丁/达福普丁、呋喃妥因、复方新诺明敏感率为92%～96%,对红霉素和克林霉素敏感率为57%～64%,对其余抗生素敏感率<40%。泛耐鲍曼不动杆菌为45.7%,泛耐铜绿假单胞菌为4.3%,产ESBLs大肠埃希菌为68.5%,产ESBLs肺炎克雷伯菌为52.9%,对甲氧西林耐药金黄色葡萄球菌分离率为78.3%。结论地震伤患者感染病原菌种类分布广、耐药严重,应根据药敏试验结果合理使用抗生素,同时做好消毒隔离工作,避免交叉感染和医院感染爆发流行。
Objective To investigate the tendency of bacterial distribution and drug-resistance in Wenchuan area during earthquake disaster,then help the clinic use drug rationally in such natural disaster.Methods Bacteria isolated from patients from May 2008 to July 2008 were identified and drug susceptibility test were performed by Vitek-32 or BD Phoenix100 automatic microbial analysis system.The presence of pan-acinetobacter baumannii and pan-pseudomonas aeruginosa,ESBLs,MRSA were determined.Results Wound infection and respiratory infection were the most common in hospitalized earthquake casualty.Infectious pathogenic bacterial distribution was wide and concluded 13 bacteria genus such as Acinetobacter spp,Pseudomonas spp,Escherichia,Enterobacter spp,Staphylococcus spp.Gram-negative bacilli was more common than Gram-positive cocci.Also co-infection infected by 2 or 3 bacterial was common.The mixed infection rate was 60.6%.The resistance of Acinetobacter baumannii was serious,the susceptible rate of antibiotics was less than 12% other than imipenem and amikacin which is 20%;80% of Pseudomonas aeruginosa were susceptible to aminoglycoside,61.4%～73.9% were susceptible to piperacillin,pipercillin/tazobactam and Cefotazine.48.6% were susceptible to imipenem.Less than 50% were susceptible to other antibiotics.100% Escherichia coli were susceptible to imipenem,73.9% to pipercillin/tazobactam,less than 35% to other antibiotics;100% Enterobacter cloacae were susceptible to imipenem,less than 30% to other antibiotics;100% Staphylococcus aureus were susceptible to imipenem and Linezolid.92%～96% to quinupristin/dalfopristin,nitrofurantoin and trimethoprim/sulfamethoxazole.57%～64% to erythromycin and clindamycin,less than 40% to others.The pan-acinetobacter baumannii,pan-pseudomonas aeruginosa and MRSA were 45.7%,4.3% and 78.3%,respectively.The ESBLs in Escherichia coli and Klebsiella pneumonia were 68.5% and 52.9%,respectively.Conclusion The pathogenic bacterial distribution isolated from earthquake casualty was wide,the resistance of antibiotics was very serious.The clinic should use antibiotics reasonably according to the drug sensitive test result.At the same time,they should do sterilization and isolation to avoid epidemic outbreak of nosocomial infection.
Objective To investigate the tendency of bacterial distribution and drug-resistance in Wenchuan area during earthquake disaster,then help the clinic use drug rationally in such natural disaster.Methods Bacteria isolated from patients from May 2008 to July 2008 were identified and drug susceptibility test were performed by Vitek-32 or BD Phoenix100 automatic microbial analysis system.The presence of pan-acinetobacter baumannii and pan-pseudomonas aeruginosa,ESBLs,MRSA were determined.Results Wound infection and respiratory infection were the most common in hospitalized earthquake casualty.Infectious pathogenic bacterial distribution was wide and concluded 13 bacteria genus such as Acinetobacter spp,Pseudomonas spp,Escherichia,Enterobacter spp,Staphylococcus spp.Gram-negative bacilli was more common than Gram-positive cocci.Also co-infection infected by 2 or 3 bacterial was common.The mixed infection rate was 60.6%.The resistance of Acinetobacter baumannii was serious,the susceptible rate of antibiotics was less than 12% other than imipenem and amikacin which is 20%;80% of Pseudomonas aeruginosa were susceptible to aminoglycoside,61.4%～73.9% were susceptible to piperacillin,pipercillin/tazobactam and Cefotazine.48.6% were susceptible to imipenem.Less than 50% were susceptible to other antibiotics.100% Escherichia coli were susceptible to imipenem,73.9% to pipercillin/tazobactam,less than 35% to other antibiotics;100% Enterobacter cloacae were susceptible to imipenem,less than 30% to other antibiotics;100% Staphylococcus aureus were susceptible to imipenem and Linezolid.92%～96% to quinupristin/dalfopristin,nitrofurantoin and trimethoprim/sulfamethoxazole.57%～64% to erythromycin and clindamycin,less than 40% to others.The pan-acinetobacter baumannii,pan-pseudomonas aeruginosa and MRSA were 45.7%,4.3% and 78.3%,respectively.The ESBLs in Escherichia coli and Klebsiella pneumonia were 68.5% and 52.9%,respectively.Conclusion The pathogenic bacterial distribution isolated from earthquake casualty was wide,the resistance of antibiotics was very serious.The clinic should use antibiotics reasonably according to the drug sensitive test result.At the same time,they should do sterilization and isolation to avoid epidemic outbreak of nosocomial infection.
引文
[1]胡必杰,陶黎黎.地震灾害伤员常见感染类型和防治对策[J].中华医院感染学杂志,2008,18(6):1~3
[2]谭虎,杨天德.地震伤患者常见感染及其防治[J].中国医药指南,2008,6(12):6~7
[3]Bulut M,Fedakar R,Akkose S,et al.Medical experience of a university hospital in Turkey after the1999Marmara earthquake[J].Emerg Med J,2000,22(7):494~498
[2]谭虎,杨天德.地震伤患者常见感染及其防治[J].中国医药指南,2008,6(12):6~7
[3]Bulut M,Fedakar R,Akkose S,et al.Medical experience of a university hospital in Turkey after the1999Marmara earthquake[J].Emerg Med J,2000,22(7):494~498
版权所有：© 2023 中国地质图书馆 中国地质调查局地学文献中心