【摘要】：目的:統(tǒng)計分析我科66例內(nèi)植物相關(guān)性慢性骨髓炎患者的菌群特點(diǎn)及耐藥情況,為臨床治療骨髓炎提供依據(jù)。方法:統(tǒng)計分析我科2012年3月至2014年12月收治的66例內(nèi)植物相關(guān)性慢性骨髓炎的細(xì)菌培養(yǎng)及藥物敏感試驗(yàn)的數(shù)據(jù)。(1)66例患者中女性13例,男性53例,患者年齡最小12歲,最大68歲,平均41歲。按部位劃分:髖關(guān)節(jié)5例,股骨24例,脛骨28例,腓骨2例,踝關(guān)節(jié)4例,跟骨1例,肱骨1例,尺骨1例。(2)17例患者術(shù)前無菌下取竇道分泌物留作標(biāo)本,所有患者初次手術(shù)清創(chuàng)前至少停用抗生素1周,術(shù)中均留取不同位置的6份標(biāo)本(死骨、內(nèi)固定物、膿液、深層壞死組織、骨髓內(nèi)、壞死與正常骨交界處)。結(jié)果:1、66例慢性骨髓炎患者術(shù)中培養(yǎng)出21種96株病原菌,3例患者培養(yǎng)出3種,24例培養(yǎng)出2種,39例培養(yǎng)出1種細(xì)菌。培養(yǎng)出57株革蘭氏陽性菌,占59.38%;38株革蘭氏陰性菌,占39.58%,1例真菌(光滑念珠菌),占1.04%。金黃色葡萄球菌檢出31株,占32.29%,比例最高,其余依次為:銅綠假單胞菌(11.46%)、耐甲氧西林金黃色葡萄球菌(MRSA)(9.38%)、表皮葡萄球菌(9.38%)、大腸埃希菌(8.33%)。2、多重耐藥菌分離出34例,占35.42%,前四位是:金黃色葡萄球菌(26.47%),表皮葡萄球菌(26.47%),大腸埃希菌(14.71%),銅綠假單胞菌(8.82%)。革蘭氏陽性菌對萬古霉素和利奈唑烷的耐藥率最低,青霉素最高。MRSA對絕大多數(shù)抗生素耐藥,未發(fā)現(xiàn)耐萬古霉素的MRSA。革蘭氏陰性菌對亞胺培南類耐藥性最低,氨芐西林類最高。銅綠假單胞菌對阿米卡星、美羅培南及喹諾酮類藥物耐藥率均為8.33%,對大多數(shù)頭孢類高度耐藥。3、17例患者術(shù)前及術(shù)中培養(yǎng)細(xì)菌比較,其中不一致的8例,占47.06%。結(jié)論:1、在內(nèi)植物相關(guān)性慢性骨髓炎患者中,革蘭氏陽性菌所占比重高于革蘭氏陰性菌。2、多重耐藥菌比例近1/3。3、規(guī)范留取標(biāo)本,可提高培養(yǎng)致病菌的準(zhǔn)確率。
[Abstract]:Objective: to analyze the bacteriological characteristics and drug resistance of 66 patients with phyto-associated chronic osteomyelitis in order to provide evidence for clinical treatment of osteomyelitis. Methods: from March 2012 to December 2014, the data of bacterial culture and drug sensitivity test in 66 patients with phyto-associated chronic osteomyelitis were analyzed. (1) 13 cases were female, 53 cases were male, the age of the patients was 12 years old. The oldest was 68 years old, with an average of 41 years old. There were 5 cases of hip joint, 24 cases of femur, 28 cases of tibia, 2 cases of fibula, 4 cases of ankle, 1 case of calcaneus, 1 case of humerus and 1 case of ulna. All patients stopped antibiotics for at least one week before debridement, and 6 specimens (dead bone, internal fixator, pus, deep necrotic tissue, bone marrow, junction between necrosis and normal bone) were taken during operation. Results: (1) in 66 patients with chronic osteomyelitis, 21 strains of 96 pathogens were cultured, 3 strains were cultured in 3 cases, 2 strains were cultured in 24 cases, and 1 strain was cultured in 39 cases. 57 Gram-positive strains were cultured, 38 Gram-negative strains were found in 59.38 strains, and 1 case of fungi (Candida smoothing) was found in 39.58 cases, accounting for 1.04%. 31 strains of Staphylococcus aureus (32.29%) were detected, and the rest were Pseudomonas aeruginosa (11.46%), methicillin-resistant Staphylococcus aureus (MRSA) (9.38%), Staphylococcus epidermidis (9.38%), Staphylococcus epidermidis (9.38%). Escherichia coli (8.33%). 34 cases (35.422%) of multidrug resistant bacteria were isolated. The first four were Staphylococcus aureus (26.47%), Staphylococcus epidermidis (26.47%), Escherichia coli (14.71%), Staphylococcus aureus (26.47%), Staphylococcus epidermidis (26.47%). Pseudomonas aeruginosa (8.82%). Gram-positive bacteria had the lowest resistance to vancomycin and linazolane, and penicillin was the highest. MRSA was resistant to most antibiotics, but no vancomycin resistant MRSA. was found. Gram-negative bacteria had the lowest resistance to imipenem, and ampicillin was the highest. The resistance rates of Pseudomonas aeruginosa to amikacin, meropenem and quinolones were 8.33, and highly resistant to most cephalosporins. Conclusion: 1. In patients with chronic osteomyelitis associated with plants, the proportion of Gram-positive bacteria is higher than that of Gram-negative bacteria.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R681.2

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