烧伤后常见感染途径及其病原菌分布和耐药性分析

Common routes of infection after burn and analysis of its pathogen distribution and drug-resistance

关键词:  烧伤  感染  细菌耐药

Key words:  [Key words]　burns  infection  bacterial resistance

摘要:

[摘要]　目的　研究武警辽宁总队医院近年烧伤患者常见感染途径及其病原菌分布和耐药性状况，为临床抗感染治疗提供参考依据。　方法　收集武警辽宁省总队医院烧伤科2011年1月—2013年12月期间烧伤感染患者资料，统计其感染途径并对其菌种分布特点及耐药性进行分析。　结果　烧伤创面是最常见的感染途径（834株占67.1%），其次是呼吸道（297株占24.0%）、静脉导管（101株占8.1%）和尿路（10株占0.8%）。革兰阴性杆菌734株占59.1%，革兰阳性球菌478株占38.5%，真菌30株占2.4%。铜绿假单胞菌检出率最高，占31.0%，其次为金黄色葡萄球菌占29.5%和鲍曼不动杆菌占9.5%。金黄色葡萄球菌只有万古霉素有较高的抗菌活性。铜绿假单胞杆菌对临床常用的抗生素呈现出较高的耐药率，耐药率在49.6%以上。而鲍曼不动杆菌同样也对临床常用的抗生素呈现出高度耐药率，耐药率在77.1%以上。　结论　创面感染是最常见的烧伤感染途径。烧伤患者所感染的病原菌中，居于前3位的依次是铜绿假单胞菌、金黄色葡萄球菌和鲍曼不动杆菌。各菌株耐药问题日益突出，合理应用抗生素、研究新抗菌药物势在必行。

Abstract:

[Abstract] Objective　To study the common routes of infection after burn and its pathogen distribution and drug-resistance in Liaoning Provincal corps hospital of Chinese people’s Armed Police and to provide reference for clinical anti-infection treatment in burn patients.　Methods　Clinical data of burn patients were collected from January 2011 to December 2013 in Liaoning Provincal corps hospital of Chinese people's Armed Police. Common routes of infection were summarized and pathogen distribution and drug-resistance rate were analyzed.　Results 　Burn wounds were the most common route of infection (834 strains, 67.1%), followed by respiratory tract (297 strains, 24.0%)、venous catheter (101 strains, 8.1%) and urinary tract (10 strains, 0.8%). 734 isolates were Gram-negative bacilli (59.1%); 478 isolates were Gram-positive cocci (38.5%) and 30 isolates were fungi (2.4%). Among them, Pseudomonas aeruginosa (PA, 31.0%) was the most highly detected pathogen, followed by Staphylococcus aureus (SA, 29.5%) and Acinetobacter baumanii (AB, 9.5%). Vancomycin was the only active antibiotic against SA with a drug resistance rate of 0.8%. PA showed high resistance (more than 49.6%) against clinically commonly used antibiotics. AB was also highly resistant with a drug resistance rate of over 77.1% against clinically commonly used antibiotics.　Conclusion　Wound infection is the most common route of infection after burn. The three dominant pathogens that cause infection in burn patients in our hospital are PA、SA and AB. The problem of drug-resistance becomes increasingly outstanding. Rational use of antibiotics and development of new antibacterial are imperative.