| 张建伟,张广斌,朱朝霞,杨 凯,宋明辉.某院 2016 年至 2020 年烧伤患者感染病原菌分布及耐药性变化趋势分析[J].中国烧伤创疡杂志,2023,(4):276~282. |
| DOI： |
| 中文关键词: 烧伤 感染 病原菌 耐药性 药物敏感性 变化趋势 |
| 英文关键词:Burn Infection Pathogen Drug resistance Drug susceptibility Change tendency |
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| 中文摘要: |
| 【摘要】 目的 分析中国人民解放军联勤保障部队第九九〇医院 2016 年至 2020 年烧伤患者感染的病原菌分布特点及耐药性变化趋势。 方法 选取 2016 年 1 月至 2020 年 12 月中国人民解放军联勤保障部队第九九〇医院接收的 4407 份烧伤患者微生物送检标本为研究对象, 分析其病原菌分布情况以及主要病原菌耐药情况。 结果 4407 份微生物送检标本中共检出病原菌 1902 株, 其中革兰氏阳性菌 857 株、革兰氏阴性菌 994 株、真菌 51株。 线性模型曲线拟合分析结果显示, 2016 年至 2020 年革兰氏阳性菌构成比呈逐渐下降趋势 (R 2 =0.774, P =0.049), 革兰氏阴性菌构成比无明显差异 (R 2 =0.440, P =0.222), 真菌构成比呈逐渐上升趋势 (R 2 = 0.822,P =0.034); 感染的病原菌中均以金黄色葡萄球菌和铜绿假单胞菌占比最高, 且金黄色葡萄球菌占比以及其中的耐甲氧西林金黄色葡萄球菌 (MRSA) 检出率均呈逐渐下降趋势 (R 2 = 0.905、0.922, P = 0.013、0.009);MRSA对青霉素、苯唑西林、红霉素的耐药性始终较高, 对左氧氟沙星与利福平的耐药性呈逐渐下降趋势 (R 2 =0.823、0.889, P =0.033、0.016), 对克林霉素的耐药性呈逐渐上升趋势 (R 2 =0.930, P =0.008), 而对万古霉素、替考拉宁、利奈唑胺始终较敏感; 铜绿假单胞菌对庆大霉素、左氧氟沙星、环丙沙星、哌拉西林他唑巴坦?亚胺培南、多黏菌素 B 的耐药性均呈逐渐下降趋势 (R 2 = 0.956、0.944、0.939、0.837、0.845、0.859, P =0.004、0.006、0.007、0.029、0.027、0.024), 且对多黏菌素 B 始终较敏感; 鲍曼不动杆菌对头孢他啶、头孢吡肟、哌拉西林他唑巴坦等药物的耐药性始终较高, 且对氨苄西林舒巴坦、复方磺胺甲噁唑的耐药性呈逐渐上升趋势 (R 2 =0.910、0.973, P =0.012、0.002), 而对多黏菌素 B 和米诺环素始终较敏感; 肺炎克雷伯菌对氨苄西林、复方磺胺甲噁唑等药物的耐药性始终较高, 对头孢唑林、氨苄西林舒巴坦、环丙沙星、左氧氟沙星的耐药性均呈逐渐上升趋势 (R 2 =0.856、0.803、0.878、0.877, P = 0.024、0.040、0.019、0.019), 对哌拉西林他唑巴坦、阿米卡星的耐药性呈逐渐下降趋势 (R 2 =0.816、0.890, P =0.036、0.016)。 结论 中国人民解放军联勤保障部队第九九〇医院 2016 年至 2020 年烧伤患者感染病原菌均以金黄色葡萄球菌和铜绿假单胞菌占比最高, 但金黄色葡萄球菌占比与其中的 MRSA 检出率以及铜绿假单胞菌的整体耐药性均呈逐渐下降趋势, 而真菌检出率逐渐上升。 |
| 英文摘要: |
| 【Abstract】 Objective To analyze the distribution characteristics of pathogens and their changes of antimicrobial resistance in burn patients in The 990th Hospital of the PLA Joint Logistics Support Force between the year 2016 and 2020.Methods A total of 4407 specimens of microorganisms from burn patients, admitted into The 990th Hospital of the PLA Joint Logistics Support Force from January 2016 to December 2020, were selected to analyze the distribution characteristics of pathogens and antimicrobial resistance of main pathogens in such patients. Results A total of 1902 strains of pathogens were detected from the 4407 specimens, of which 857 strains were gram-positive bacterium, 994 strains were gram-negative bacterium and 51 were fungi. The curve-fitting using linear regression analysis showed that the proportion of gram-positive bacterium decreased year by year (R 2 =0.774, P =0.049), the proportion of gram-negative bacterium didn’t change much over the years (R 2 =0.440, P =0.222), and the proportion of fungi increased year by year (R 2 = 0.822, P = 0.034). Among the pathogens in burn wounds, staphylococcus aureus and pseudomonas aeruginosa accounted for the highest proportion, but the proportion of staphylococcus aureus and the detection rate of methicillin resistant staphylococcus aureus (MRSA) showed a trend of decrease year by year (R 2 = 0.905 and 0.922, P = 0.013 and 0.009). The resistance ofMRSA to penicillin, oxacillin and erythromycin maintained high over the years, its resistance to levofloxacin and rifampicin showed downward trend year by year (R 2 = 0.823 and 0.889, P = 0.033 and 0.016) and its resistance to clindamycin showed an upward trend year by year (R 2 = 0.930, P = 0.008), but its susceptibility to vancomycin, teicoplanin and linezolid was always very high. The resistance of pseudomonas aeruginosa to gentamicin, levofloxacin, ciprofloxacin, piperacillin/ tazobactam, imipenem, polymyxin B showed a decrease trend year by year (R 2 = 0.956, 0.944, 0.939,0.837, 0.845 and 0.859, P = 0.004, 0.006, 0.007, 0.029, 0.027 and 0.024), and its susceptibility to polymyxin B was always high. The resistance of acinetobacter baumannii to ceftazidime, cefepime and piperacillin/ tazobactam maintained high over the years, and its resistance to ampicillin/ salbactam and compound sulfamethoxazole showed an increase trend over the years (R 2 =0.910 and 0.973, P =0.012 and 0.002), and its susceptibility to polymyxin B and minocycline maintained high. The resistance of Klebsiella pneumoniae to ampicillin, compound sulfamethoxazole remained high, its resistance to cefazolin, ampicillin/ salbactam, ciprofloxacin and levofloxacin increased year by year (R 2 =0.856, 0.803, 0.878 and 0.877, P =0.024, 0.040, 0.019 and 0.019), and its resistance to piperacillin/ tazobactam and amikacin decreased over the years (R 2 =0.816 and 0.890, P =0.036 and 0.016). Conclusion Among the pathogens found in burn patients admitted into The 990th Hospital of the PLA Joint Logistics Support Force between 2016 and 2020, staphylococcus aureus and pseudomonas aeruginosa occupied the highest proportion, but the proportion of staphylococcus aureus, the detection rate of MRSA and the overall drug resistance of pseudomonas aeruginosa all showed a decrease trend year by year, while the detection rate of fungi increased over the years. |
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