摘要
目的分析全膝关节置换术(TKA)术后迟发性感染患者关节液中病原菌分布及耐药性。方法回顾性分析信阳市人民医院2019年1月至2020年12月收治的49例行TKA术后迟发性感染患者临床资料。取关节液进行细菌培养,分析TKA术后迟发性感染患者关节液中病原菌分布及药敏结果。结果 49例迟发性感染患者送检的标本共分离出病原菌54株,其中革兰阳性菌30株,占55.56%(30/54),革兰阴性菌18株,占33.33%(18/54),真菌4株,占7.41%(4/54),偶发分枝杆菌1例,占1.85%(1/54),病原菌谱复杂;革兰阳性菌主要以金黄色葡萄球菌、表皮葡萄球菌为主,革兰阴性菌主要以大肠埃希菌、铜绿假单胞菌为主。主要革兰阳性菌中,耐药性较高的抗生素有青霉素、红霉素,耐药性较低的有万古霉素、替加环素、利奈唑胺、利福平、莫西沙星、庆大霉素等,而金黄色葡萄球菌对苯唑西林、喹诺酮类、复方新诺明的耐药性低于表皮葡萄球菌;主要革兰阴性菌中,耐药性较低的抗生素有阿米卡星、亚胺培南、头孢吡肟、头孢他啶、哌拉西林/他唑巴坦;大肠埃希菌耐药性较高的有头孢呋辛、头孢曲松、左旋氧氟沙星;铜绿假单胞菌耐药性较高的有替卡西林/克拉维酸。结论金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌、铜绿假单胞菌是导致TKA患者术后迟发性感染的主要病原菌,临床工作者可根据病原谱耐药数据分析来调整抗生素的使用,以此改善术后迟发性感染发生率和治疗率。
Objective To analyze the distribution and drug resistance of pathogens in synovial fluid of patients with delayed infection after total knee arthroplasty(TKA).Methods The clinical data of 49 patients with delayed infection after TKA treated in Xinyang People’s Hospital from January 2019 to December 2020 were retrospectively analyzed.The joint fluid was taken for bacterial culture.The distribution and the results of drug sensitivity of pathogens in synovial fluid of patients with delayed infection after TKA were analyzed.Results Fifty-four strains of pathogens were isolated from the samples submitted for examination of 49 patients with delayed infection.Of which,there were 30 strains of Gram-positive bacteria,accounting for 55.56%(30/54),18 strains of Gram-negative bacteria,accounting for 33.33%(18/54),4 strains of fungi,accounting for 7.41%(4/54),1 case of occasional Mycobacterium,accounting for 1.85%(1/54).The pathogen spectrum was complex.Gram positive bacteria were mainly Staphylococcus aureus and Staphylococcus epidermidis,while gram negative bacteria were mainly Escherichia coli and Pseudomonas aeruginosa.Among the main Gram-positive bacteria,the antibiotics with high drug resistance were penicillin and erythromycin,while those with low drug resistance were vancomycin,tigecycline,linezolid,rifampicin,moxifloxacin and gentamicin.The resistance of Staphylococcus aureus to oxacillin,quinolones and cotrimoxazole were significantly lower than that of Staphylococcus epidermidis.Among the main Gram-negative bacteria,the antibiotics with low drug resistance were amikacin,imipenem,cefepime,ceftazidime,piperacillin/tazobactam.The high drug resistance of Escherichia coli were cefuroxime,ceftriaxone and levofloxacin.The higher drug resistance of Pseudomonas aeruginosa was ticarcillin/clavulanic acid.Conclusion Staphylococcus aureus,Staphylococcus epidermidis,Escherichia coli and Pseudomonas aeruginosa are the main pathogens causing delayed infection in patients after TKA.Clinical workers can adjust the use of antibiotics according to the analysis of drug resistance data of pathogen spectrum,so as to improve the incidence and treatment rate of postoperative delayed infection.
作者
许猛
江立千
XU Meng;JIANG Liqian(Department of Laboratory Medicine,Xinyang People’s Hospital,Xinyang 464000,China)
出处
《河南医学研究》
CAS
2021年第18期3419-3422,共4页
Henan Medical Research
关键词
全膝关节置换术
迟发性感染
病原菌分布
细菌耐药性
关节液
total knee arthroplasty
delayed infection
distribution of pathogenic bacteria
bacterial resistance
synovial fluid
