摘要
目的:探究开放性骨折患者伤口分泌物的细菌培养及感染原因。方法:无菌条件下,用无菌棉拭子分别取患者在首次入院伤口清创前与第二次清创后(或手术后) 8 h的分泌标本,将标本装入无菌管中送检,在入院2~5 d后,视患者具体病情再采集标本1~2次,装入无菌管送检。分别将标本接种在培养基中,在37℃的恒温培养箱中培养24 h,观察菌落的形态,然后进行革兰染色,确定细菌种属。在M-H培养基上将菌液涂抹均匀,粘贴药敏纸贴,将温度维持在37℃,培养18~24 h,测量抗菌药物抑菌环的直径,并判定敏感情况。比较两组检出细菌对几种抗菌药物的耐药率。结果:分析病原菌组成及感染情况发现该组240例患者中在清创前的伤口分泌物经培养、分离、鉴定出194例病原菌,阳性率为80.8%(194/240)。其中革兰阴性(G^-)菌为主要致病菌,共128例,占66.0%(128/194),革兰阳性(G^+)菌66例,占34.0%(66/194)。清创后8 h的伤口分泌物经培养、分离、鉴定出50例,阳性率为20.8%(50/240),χ^2=72.01,清创后8 h与清创前阳性率差异有统计学意义(P<0.05)。通过比较致病菌对不同抗生素敏感性发现,致病菌对第三代头孢菌素和万古霉素具有很高的敏感性,杀伤性较强,而对青霉素的敏感性最低,可能与青霉素的滥用和超负荷使用引起致病菌耐药性有关。结论:骨科开放性伤口的感染主要为革兰阴性菌,及时采取相应的措施对伤口清创,防止出现感染。
Objective To investigate the bacterial culture and infection causes of wound secretions in patients with open fractures.Method Under sterile conditions,a sterile cotton swab was used to obtain secreted specimens from patients before the first debridement of wounds and 8 hours after the second debridement(or after surgery).The specimens were packed in sterile tubes and sent.Inspection,2 to 5 days after admission,depending on the patient’s specific condition,take another sample 1~2 times,put it into a sterile tube for inspection.Specimens were inoculated in the culture medium,cultured in a constant temperature incubator at 37°C for 24 hours,the morphology of the colonies was observed,and then Gram staining was performed to determine the bacterial species.Then spread the bacterial solution evenly on the M-H medium,paste the medicine-sensitive paper,maintain the temperature at 37°C,and incubate for 18~24 hours,measure the diameter of the antibacterial ring,and determine the sensitivity.The resistance rates of the detected bacteria to several antibacterial drugs were compared between the two groups.Results Analysis of pathogenic bacteria composition and infection revealed that wound secretions before debridement in this group of 240 patients were cultured,isolated,and identified 194 pathogenic bacteria,with a positive rate of80.8%(194/240).Among them,Gram-negative bacteria(G^-)were the main pathogenic bacteria,a total of 128 cases,accounting for 66.0%(128/194),and 66 Gram-negative bacteria(G^+),accounting for 34.0%(66/194).Fifty cases of wound secretion at 8 hours after debridement were cultured,isolated,and identified.The positive rate was 20.8%(50/240),χ^2=72.01.The difference between the positive rate at 8 hours after debridement and before debridement was statistically significant(P<0.05).By comparing the sensitivity of the pathogens to different antibiotics,it was found that the pathogens were highly sensitive to third-generation cephalosporins and vancomycin,and have strong lethality,while the lowest sensitivity to penicillin may be related to the abuse of penicillin.And overloaded use,causing resistance to pathogenic bacteria.Conclusion The infection of open wounds in orthopedics is mainly Gram-negative bacteria,and timely measures should be taken to debride the wounds in time to prevent infection.
作者
李悦
狄勇
赵继磊
LI Yue;DI Yong;ZHAO Ji-lei(Department of orthopaedics,Langfang Aidebao hospital,Langfang 065000,China)
出处
《吉林医学》
CAS
2020年第7期1553-1555,共3页
Jilin Medical Journal
关键词
开放性骨折
分泌物
细菌培养
耐药性
Open fracture
Secretion
Bacterial culture
Drug resistance
