發(fā)布時(shí)間：2018-10-05 16:31

【摘要】：目的探討新鮮開放性骨折(open fracture)患者感染前后創(chuàng)面細(xì)菌種類及其藥敏試驗(yàn)(Antimicrobial susceptibility test,AST)情況,以期指導(dǎo)臨床抗生素的使用。方法42例于2015年5月至2016年8月我院收治的新鮮開放性骨折并后續(xù)發(fā)生感染的患者,統(tǒng)計(jì)其入院急診清創(chuàng)術(shù)中,以及感染發(fā)生后分別進(jìn)行創(chuàng)面細(xì)菌培養(yǎng)及藥敏試驗(yàn)情況,并對(duì)結(jié)果進(jìn)行分析。結(jié)果急診清創(chuàng)術(shù)中創(chuàng)面細(xì)菌培養(yǎng)陽性者4例,共培養(yǎng)出4例病原菌,均為陰溝腸桿菌(Enterobacter cloacae)及大腸埃希菌(Escherichia coli,E.coli),且同感染后培養(yǎng)出相同的病原菌者僅1例;感染發(fā)生后細(xì)菌培養(yǎng)陽性者40例,共培養(yǎng)出48株病原菌,主要為銅綠假單胞菌(P.Aeruginosa)14株,大腸埃希菌12株,鮑曼不動(dòng)桿菌(Acinetobacter baumannii,Ab)4株,肺炎克雷伯菌(Klebsiella Pneumoniae,Kpn)4株,陰溝腸桿菌2株,表皮葡萄球菌(Staphylococcus epidermidis)6株,金黃色葡萄球菌(Staphylococcus aureus)6株,多為革蘭陰性菌(75%,36/48);頭孢哌酮、左氧氟沙星對(duì)于各主要病原菌敏感性較高,耐藥率均35%;共培養(yǎng)出6株多重耐藥菌(multiple resistant bacteria,MDR),對(duì)臨床常用抗菌藥普遍耐藥。結(jié)論無法根據(jù)急診清創(chuàng)術(shù)中細(xì)菌培養(yǎng)情況推測(cè)引起后續(xù)感染的致病菌,開放性骨折感染多由革蘭陰性菌所致。MDR占有不小比例,需嚴(yán)格控制院內(nèi)感染,臨床治療上需根據(jù)感染后細(xì)菌培養(yǎng)結(jié)果調(diào)整抗生素使用,才能更好地預(yù)防和控制感染。
[Abstract]:Objective to investigate the bacterial species and drug sensitivity test (Antimicrobial susceptibility test,AST) in patients with fresh open fracture (open fracture) before and after infection, in order to guide the clinical use of antibiotics. Methods from May 2015 to August 2016, 42 patients with fresh open fracture and subsequent infection were collected, and the bacterial culture and drug sensitivity test were performed in the patients who were admitted to the hospital for emergency debridement, as well as after the infection. The results were analyzed. Results in emergency debridement, 4 cases were positive for bacteria culture, 4 cases were Enterobacter cloacae (Enterobacter cloacae) and Escherichia coli (Escherichia coli,E.coli), and only 1 case had the same bacteria after infection. After infection, 48 strains of pathogenic bacteria were cultured, including 14 strains of Pseudomonas aeruginosa (P.Aeruginosa), 12 strains of Escherichia coli, 4 strains of Acinetobacter baumannii (Acinetobacter baumannii,Ab), 4 strains of Klebsiella pneumoniae (Klebsiella Pneumoniae,Kpn) and 2 strains of Enterobacter cloacae. Six strains of Staphylococcus epidermidis (Staphylococcus epidermidis) and six strains of Staphylococcus aureus (Staphylococcus aureus) were Gram-negative bacteria (75 / 36 / 48), and cefoperazone and levofloxacin were highly sensitive to major pathogens. 6 strains of multidrug resistant bacteria (multiple resistant bacteria,MDR) were cultured, and they were generally resistant to antibiotics commonly used in clinic. Conclusion it is impossible to speculate the bacteria that cause subsequent infection according to the condition of bacterial culture in emergency debridement. The infection of open fracture is caused by Gram-negative bacteria in large proportion, so it is necessary to strictly control the nosocomial infection. In order to prevent and control infection, we should adjust the use of antibiotics according to the results of bacterial culture after infection.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R683

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