不同烧伤面积患者创面感染病原菌分布及其耐药性

Distribution and antimicrobial resistance of pathogens of wound infection in patients with different burn areas

摘要:

目的 调查分析不同烧伤面积患者创面感染病原菌分布特点及其耐药情况，为临床合理使用抗菌药物提供参考。 方法 调查2015—2020年北京积水潭医院收治的烧伤患者创面感染的细菌培养结果，根据患者烧伤面积与体表面积比例的不同，分为 < 10%烧伤面积占总体表面积（TBSA）、10%~49% TBSA和≥50% TBSA 3组，分析不同烧伤面积下创面感染的病原菌分布特点，测定抗菌药物对主要病原菌的最低抑菌浓度，采用χ²检验比较不同烧伤面积组间细菌的耐药率。 结果 共分离456株烧伤患者创面感染细菌，其中烧伤面积 < 10% TBSA组120株，10%~49% TBSA组135株，≥50% TBSA组201株。其中革兰阴性菌占52.2%（238株），以铜绿假单胞菌（104株，占22.8%）、鲍曼不动杆菌（39株，占8.5%）及肺炎克雷伯菌（27株，5.9%）为主；革兰阳性菌占47.8%（218株），以表皮葡萄球菌（50株，占11.0%）和金黄色葡萄球菌（44株，占9.6%）为主。不同烧伤面积创面感染的病原菌分布及耐药率不同。烧伤面积 < 10% TBSA时，病原菌以金黄色葡萄球菌为主；10%~49% TBSA组及≥50% TBSA组则以铜绿假单胞菌和鲍曼不动杆菌为主。≥50% TBSA组的细菌耐药率升高，其中铜绿假单胞菌对头孢类及碳青霉烯类抗生素耐药率分别为87.9%（58/66）、93.9%（62/66）；检出的25株鲍曼不动杆菌均为多重耐药菌；耐甲氧西林金黄色葡萄球菌（MRSA）检出率为100%（9/9），高于 < 10% TBSA组和10%~49% TBSA组烧伤患者，差异有统计学意义（χ²=6.836，P < 0.05）。 结论 不同烧伤面积患者创面感染的病原菌分布不同，烧伤面积 < 10%时以革兰阳性菌为主，烧伤面积达10%以上时以革兰阴性菌为主，烧伤面积≥50%时细菌耐药性及多重耐药菌比例明显增加。

Abstract:

Objective To investigate and analyze distribution characteristics and antimicrobial resistance of pathogens of wound infection in patients with different burn areas, so as to provide reference for clinical rational use of antimicrobial agents. Methods Bacterial culture results of burn patients with wound infection treated in Beijing Jishuitan Hospital from 2015 to 2020 were investigated, according to the different ratio of burn area to total body surface area (TBSA), patients were divided into three groups: less than 10% TBSA, 10%-49% TBSA and ≥ 50% TBSA groups. Distribution characteristics of pathogens of wound infection under different burn areas were analyzed, minimum inhibitory concentration of antimicrobial agents against main pathogens was detected, antimicrobial resistance rates of bacteria in different burn area groups were compared by χ² test. Results A total of 456 strains of wound infection bacteria were isolated from burn patients, including 120 strains in burn area < 10% TBSA group, 135 strains in 10%-49% TBSA group and 201 strains in ≥ 50% TBSA group. Gram-negative bacteria accounted for 52.2% (238 strains), mainly Pseudomonas aeruginosa (104 strains, 22.8%), Acinetobacter baumannii (39 strains, 8.5%) and Klebsiella pneumoniae (27 strains, 5.9%); Gram-positive bacteria accounted for 47.8% (218 strains), mainly Staphylococcus epidermidis (50 strains, 11.0%) and Staphylococcus aureus (44 strains, 9.6%). Distribution and resistance rate of pathogens causing wound infection at different burn areas were different. When burn area < 10% TBSA, Staphylococcus aureus was the main pathogen; the main pathogen were Pseudomonas aeruginosa and Acinetobacter baumannii in 10%-49% group and ≥ 50% TBSA group. Antimicro-bial resistance rate of bacteria in ≥ 50% TBSA group increased, resistance rates of Pseudomonas aeruginosa to cephalosporins and carbapenems were 87.9% (58/66) and 93.9% (62/66) respectively; the isolated 25 strains of Acinetobacter baumannii were multidrug-resistant strains; isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) was 100% (9/9), which was significantly higher than that of burn patients in < 10% TBSA group and 10%-49% TBSA group (χ²=6.836, P < 0.05). Conclusion Distribution of pathogens of wound infection in patients with different burn areas is different, when burn area < 10% and ≥ 10%, the main pathogens are Gram-positive bacteria and Gram-negative bacteria respectively, when burn area ≥ 50%, the proportion of bacterial resis-tance and multidrug-resistant organism increased obviously.