| 陈中坚,林 迪,罗良文,宋雪芬,余健雄,陈少娴,苏雁华,吴伟洪,李铭杰,张月琼.持续负压封闭引流治疗过程中感染创面病原菌分布及耐药性变化情况分析[J].中国烧伤创疡杂志,2022,(5):330~334. |
| DOI： |
| 中文关键词: 负压封闭引流 创面感染 病原菌 耐药性 变迁 |
| 英文关键词:Vacuum sealing drainage Wound infection Pathogenic bacteria Drug resistance Transition |
| 基金项目:江门市科技计划项目 (2013019) |
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| 中文摘要: |
| 【摘要】 目的 分析持续负压封闭引流治疗过程中感染创面病原菌分布及耐药性变化情况。 方法 选取 2014年4月至2018年4月开平市中心医院收治的56例合并感染的急慢性创面患者作为研究对象,均行持续负压封闭引流治疗,对治疗前及治疗后1、7d创面分泌物进行病原菌及药物敏感试验分析。结果 56例患者治疗前共分离出革兰氏阴性杆菌40株 (70.18%)、革兰氏阳性球菌16株(28.07%)、真菌1株 (1.75%),治疗1 d后共分离出革兰氏阴性杆菌37株 (52.86%)、革兰氏阳性球菌25株(35.71%)、真菌8株(11.43%),治疗7 d后共分离出革兰氏阴性杆菌50株(63.29%)、革兰氏阳性球菌 21株(26.58%)、真菌8株(10.13%),治疗前至治疗1 d后共30例 (53.57%)患者菌株出现转阴或改变,治疗1d后至治疗7 d后共19例(33.93%)患者菌株出现转阴或改变。治疗前至治疗1、7d后,病原菌耐药性未见明显变化,其中主要革兰氏阴性杆菌对青霉素、哌拉西林他唑巴坦、头孢西丁具有较高的耐药性, 而对亚胺培南、丁胺卡那的耐药性较低；革兰氏阳性球菌对青霉素耐药性较低, 且未发现去甲万古霉素耐药菌株。结论 持续负压封闭引流治疗过程中感染创面病原菌变迁以革兰氏阴性杆菌向兼性厌氧革兰氏阳性球菌转变为主, 且治疗前定植菌种中革兰氏阴性杆菌比例高达70.18%并对亚胺培南、丁胺卡那敏感性较高, 临床治疗中可予以借鉴。 |
| 英文摘要: |
| 【Abstract】 Objective To analyze the distribution and changes of drug resistance of pathogenic bacteria in infected wounds during continuous vacuum sealing drainage (VSD).Methods 56 patients with acute and chronic wounds complicated with infection, admitted to Kaiping Central Hospital from April 2014 to April 2018, were enrolled as research subjects. All patients were treated with continuous VSD. The pathogenic bacteria and drug sensitivity tests were performed on wound secretion respectively before treatment and on day 1 and day 7 after treatment. Results Before treatment, 40 strains of gram-negative bacilli (70.18%), 16 strains of gram-positive cocci (28.07%) and 1 strain of fungi (1.75%)were isolated from the 56 patients. After one day of treatment, 37 strains of gram-negative bacilli (52.86%), 25 strains of Gram-positive cocci (35.71%), and 8 strains of fungi (11.43%) were isolated; after seven days of treatment, 50 strains of gram-negative bacilli (63.29%), 21 strains of gram-positive cocci (26.58%) and 8 strains of fungi (10.13%) were isolated. After one day of treatment, bacterial strains converted into negative or changed in 30 patients (53.57%). From day 1 to day 7 of treatment, bacterial strains in 19 patients (33.93% ) converted into negative or changed. Compared with that before treatment, the drug resistance of pathogenic bacteria didn’t change significantly respectively after one day and 7 days of treatment. It was found that main Gram-negative bacteria generally had much high resistance to Penicillin, Piperacillin Tazobactam and Cefoxitin, but low resistance to Imipenem and Amikacin; Gram positive cocci had low resistance to Penicillin, and no norvancomycin-resistant strains were found. Conclusion In the course of continuous VSD, the transition of pathogenic bacteria in infected wounds was mainly from Gram-negative bacteria to facultative anaerobic gram-positive cocci; before treatment, Gram-negative bacteria accounted for 70 Imipenem and Amikacin, and the finding may provide useful reference for clinical practice. |
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