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  • Title: [Analysis of distribution and drug resistance of pathogens from the wounds of 1 310 thermal burn patients].
    Author: Zhang C, Gong YL, Luo XQ, Liu MX, Peng YZ.
    Journal: Zhonghua Shao Shang Za Zhi; 2018 Nov 20; 34(11):802-808. PubMed ID: 30481922.
    Abstract:
    Objective: To analyze the distribution and drug resistance of pathogens from the wounds of thermal burn patients, so as to provide reliable basis for the rational use of antibiotics and the effective control over nosocomial infection. Methods: Wound samples of 1 310 thermal burn patients admitted into our burn wards from January 2012 to December 2017 were collected and retrospectively analyzed. API bacteria identification panels and automatical bacteria identification equipment were used to identify pathogens. E test was conducted to detect drug resistance of pathogens to vancomycin, tigecycline, and oxacillin. Kirby-Bauer paper disk diffusion method was used to detect drug resistance of pathogens to 31 antibiotics including penicillin G, gentamicin and rifampicin, etc., and drug resistance of fungi to 5 antifungal agents (voriconazole, amphotericin B, fluconazole, itraconazole, and ketoconazole). The WHONET 5.6 software was used to analyze the constituent ratios of Gram-negative bacteria, Gram-positive bacteria, and fungi in each year; the distribution of fungi; the distribution of top 10 bacteria with the highest constituent ratios in each year; the constituent ratios of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA); the drug resistance of top 3 bacteria with the highest constituent ratios to commonly used antibiotics in each year; and the drug resistance of Candida to commonly used antifungal agents. Results: (1) Totally 2 183 strains of pathogens were isolated for the first time, including Gram-negative bacteria 1 194 (54.70%) strains, Gram-positive bacteria 879 (40.27%) strains, and fungi 110 (5.04%) strains. From 2012 to 2016, the constituent ratio of Gram-negative bacteria showed a decreasing trend, while that of Gram-positive bacteria showed an increasing trend year by year; and the constituent ratio of fungi was with a significantly increasing trend from 2016 to 2017. (2) Among all the fungi, the constituent ratio of Candida parapsilosis ranked the first, Aflatoxin ranked the second, Candida albicans and Candida tropicalis both ranked the third. (3) From 2012 to 2017, top 10 bacteria with the highest constituent ratios, from high to low, were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Staphylococcus haemolyticus, Klebsiella pneumoniae, Enterococcus faecalis, Aeromonas hydrophila, and Stenotrophomonas maltophilia respectively. The constituent ratio of Staphylococcus aureus ranked the first in each year. The constituent ratio of Pseudomonas aeruginosa was fluctuating but showed a rising trend comprehensively. The constituent ratio of Acinetobacter baumannii went up after decreasing. (4) Among all the Staphylococcus aureus, constituent ratio of MRSA was above 65.00%, while that of MSSA was below 31.00% in each year. (5) From 2012 to 2017, Staphylococcus aureus resistant to vancomycin, linezolid, or teicoplanin was not detected; the drug-resistant rates of MRSA to penicillin G, oxacillin, gentamicin, rifampicin, tetracycline, ciprofloxacin, ofloxacin, and levofloxacin were above or equal to 80.0% in each year; the drug-resistant rates of Staphylococcus aureus to clindamycin and erythrocin showed an obviously increasing trend, the drug-resistant rates of Staphylococcus aureus to moxifloxacin and queenoputin/daputin in 2017 were higher than those in 2016, while the drug-resistant rates of Staphylococcus aureus to the other 14 antibiotics showed no significant change in trend. From 2012 to 2017, Acinetobacter baumannii was sensitive to polymyxin B and tigecycline; the drug-resistant rate of Acinetobacter baumannii to ceftriaxone was relatively high; the drug-resistant rates of Acinetobacter baumannii to levofloxacin, minocycline, and tetracycline were decreasing while those to the other 14 antibiotics went up after decreasing. From 2012 to 2017, Pseudomonas aeruginosa wasn't resistant to polymyxin B, and its drug-resistant rates to the other 14 antibiotics showed decreasing trends. (6) The drug-resistant rates of Candida albicans to voriconazole, amphotericin B, fluconazole, itraconazole, and ketoconazole were all zero. The drug-resistant rates of non-Candida albicans to voriconazole, fluconazole, itraconazole, and ketoconazole were higher than those of Candida albicans. Conclusions: Among the pathogens from the wounds of thermal burn patients, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii had the top 3 constituent ratios; the constituent ratio of non-Candida albicans was obviously higher than that of Candida albicans. The high drug resistance rates of Staphylococcus aureus and Acinetobacter baumanni require more attention from clinicians and the local hospital's infection control department. 目的： 分析热力烧伤患者的创面病原菌分布情况及耐药性，为临床合理使用抗菌药物及控制医院内感染提供可靠依据。 方法： 收集笔者单位2012年1月—2017年12月收治的1 310例热力烧伤住院患者的创面标本进行回顾性分析。采用API细菌鉴定板条和全自动细菌鉴定仪进行病原学鉴定。E试验检测病原菌对万古霉素、替加环素及苯唑西林的耐药性；K－B纸片扩散法检测病原菌对青霉素G、庆大霉素、利福平等31种抗菌药物的耐药性，对伏立康唑、两性霉素B、氟康唑、伊曲康唑、酮康唑5种抗真菌药物的耐药性。采用WHONET 5.6软件分析各年度革兰阴性菌、革兰阳性菌及真菌构成比，真菌分布情况，各年度构成比居前10位的细菌分布情况，各年度抗甲氧西林金黄色葡萄球菌(MRSA)和甲氧西林敏感金黄色葡萄球菌(MSSA)的构成比，各年度构成比居前3位的细菌对常用抗菌药物的耐药情况，念珠菌对常用抗真菌药物的耐药情况。 结果： (1)共检出病原菌2 183株，均为非重复首次分离菌株，其中革兰阴性菌1 194株，占54.70%；革兰阳性菌879株，占40.27%；真菌110株，占5.04%。2012—2016年革兰阴性菌的构成比呈逐年下降趋势，革兰阳性菌构成比呈逐年上升趋势，真菌的构成比在2016—2017年上升趋势明显。(2)在所有真菌中，近平滑念珠菌构成比居首位，黄曲霉居第2位，白念珠菌、热带念珠菌构成比均居于第3位。(3)2012—2017年，构成比居前10位的细菌从高到低依次为金黄色葡萄球菌、铜绿假单胞菌、鲍氏不动杆菌、阴沟肠杆菌、大肠杆菌、溶血葡萄球菌、肺炎克雷伯菌、粪肠球菌、嗜水气单胞菌、嗜麦芽窄食单胞菌。金黄色葡萄球菌的构成比每年均居于首位；铜绿假单胞菌的构成比有波动，但总体呈上升趋势；鲍氏不动杆菌的构成比先下降后上升。(4)检出的金黄色葡萄球菌中，MRSA的构成比每年均>65.00%，MSSA的构成比每年均<31.00%。(5)2012—2017年，未检出对万古霉素、利奈唑胺、替考拉宁耐药的金黄色葡萄球菌；MRSA对青霉素G、苯唑西林、庆大霉素、利福平、四环素、环丙沙星、氧氟沙星、左氧氟沙星的耐药率每年均≥80.0%；金黄色葡萄球菌对克林霉素和红霉素的耐药率呈明显上升趋势，对莫西沙星、奎奴普丁/达福普汀的耐药率2017年明显高于2016年，而对其余14种抗菌药物的耐药率无明显变化趋势。2012—2017年，鲍氏不动杆菌对多黏菌素B及替加环素均敏感，对头孢曲松的耐药率较高，对左氧氟沙星、米诺环素及四环素的耐药率呈下降趋势，而对其余14种抗菌药物的耐药率先下降后上升。2012—2017年，铜绿假单胞菌对多黏菌素B不耐药，对其余14种抗菌药物的耐药率均呈下降趋势。(6)白念珠菌对伏立康唑、两性霉素B、氟康唑、伊曲康唑、酮康唑耐药率均为0，非白念珠菌对伏立康唑、氟康唑、伊曲康唑、酮康唑耐药率均高于白念珠菌。 结论： 热力烧伤患者创面感染的病原菌中，金黄色葡萄球菌、铜绿假单胞菌及鲍氏不动杆菌的构成比居前3位；非白念珠菌的构成比明显高于白念珠菌；金黄色葡萄球菌和鲍氏不动杆菌耐药形势严峻，临床医师及医院感染控制科需重点关注。.
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