对比分析新旧病区烧伤患者感染病原菌的分布及耐药情况。

分别选择安徽医科大学第一附属医院烧伤科新旧病区2017年10月至2019年10月收治的烧伤面积≥30%总体表面积(TBSA)的烧伤患者45例、91例，收集创面分泌物、血液、痰液、尿液、粪便、深静脉导管、气管套管标本中分离的菌株，采用全自动微生物鉴定分析仪进行菌株鉴定，K-B纸片扩散法进行药物敏感试验。统计分析新旧病区烧伤患者感染病原菌分布及检出率最高的革兰氏阴性菌、革兰氏阳性菌的耐药情况，并对真菌的耐药情况进行了分析。数据行χ²检验或Fisher确切概率法。

新病区共检出病原菌196株，革兰氏阴性菌149株(76.02%)，革兰氏阳性菌25株(12.76%)，真菌22株(11.22%)。旧病区共检出病原菌302株，革兰氏阴性菌241株(79.80%)，革兰氏阳性菌41株(13.58%)，真菌20株(6.62%)。新旧病区革兰氏阴性菌、革兰氏阳性菌、真菌的检出率比较，差异均无统计学意义(P>0.05)。新病区检出率最高的革兰氏阴性菌是肺炎克雷伯菌[37株(18.88%)]，与旧病区[50株(16.56%)]相比，差异无统计学意义(χ²＝0.887，P＝0.346)；旧病区检出率最高的革兰氏阴性菌是铜绿假单胞菌[91株(30.13%)]，与新病区[17株(8.67%)]相比，差异有统计学意义(χ²＝ 31.927，P<0.05)；新旧病区检出率最高的革兰氏阳性菌均为金黄色葡萄球菌，检出率分别为4.08%，5.30%，差异无统计学意义(P＝0.565)。新病区检出的肺炎克雷伯菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢吡肟耐药率分别为37.84%、40.54%、51.35%、59.46%，与旧病区(64.00%、74.00%、76.00%、86.00%)相比，差异均有统计学意义(P<0.05)。旧病区检出铜绿假单胞菌对环丙沙星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率分别为67.03%、65.93%、53.84%，与新病区(41.18%、35.29%、11.76%)相比，差异均有统计学意义(P<0.05)。新旧病区检出的金黄色葡萄球菌对利福平、喹诺酮类、庆大霉素等耐药率均在60.00%以上。新旧病区暂未检出对临床常用药物如氟康唑、伏立康唑耐药的真菌菌株。

新旧病区烧伤患者感染病原菌的菌种分布及耐药情况存在一定差异且多重耐药严重，定期检查和诊断常见细菌及其耐药模式，以确定合适的抗生素方案，进行适当的治疗。

To compare and analyze the distribution of pathogenic bacteria and drug resistance of burn patients in old and new ward.

Forty-five and 91 burn patients with burn area ≥30% total body surface area (TBSA) were selected from the old and new ward of Department of Burns, First Affiliated Hospital of Anhui Medical University from October 2017 to October 2019. Strains isolated from wound secretions, blood, sputum, urine, feces, deep vein catheter and tracheal cannula were collected by the automatic microbial identification analyzer, and drug sensitivity test was conducted by K-B disk diffusion method. The distribution and type of pathogenic bacteria and the drug resistance rate of gram-negative bacteria and gram-positive bacteria with the highest detection rate were analyzed, the drug resistance rate of fungi were also analyzed. Data were processed with chi-square test or Fisher′s exact probability method.

A total of 196 strains of pathogenic bacteria were detected in the new ward, including 149 (76.02%) gram-negative bacteria, 25 (12.76%) gram-positive bacteria and 22 (11.22%) fungi. A total of 302 strains of pathogenic bacteria were detected, including 241(79.80%) gram-negative bacteria, 41 (13.58%) gram-positive bacteria, and 20(6.62%) fungi. There were no significant difference in the detection rates of gram-negative bacteria, gram-postive bacteria and fungi in the old and new wards. The gram-negative bacteria with the highest detection rate in the new ward was klebsiella pneumoniae [37 (18.88%)], compared with the old ward [50 (16.56%)], there was no significant difference (χ²=0.887, P=0.346). The gram-negative bacteria with the highest detection rate of in the old ward was pseudomonas aeruginosa [91 (30.13%)], compared with the new ward [17 (8.67%)], the difference was statistically significant (χ²=31.927, P<0.05). The highest detection rate of gram-positive bacteria were staphylococcus aureus in both old and new wards, and the detection rates were 4.08% and 5.30%, respectively, and the difference was not statistically significant (P=0.565). The drug resistance rates of klebsiella pneumoniae to imipenem, meropenem, piperacillin/tazobactam and cefepime in the new ward were 37.84%, 40.54%, 51.35% and 59.46%, respectively, compared with the old ward [64.00%, 74.00%, 76.00% and 86.00%], the differences were statistically significant (P<0.05). The drug resistance rates of pseudomonas aeruginosa to ciprofloxacin, cefoperazone/sulbactam and piperacillin/tazobactam were 67.03%, 65.93%, 53.84%, respectively in the old ward, compared with the new ward [41.18%, 35.29%, 11.76%], the differences were statistically significant (P<0.05). The drug resistance rate of staphylococcus aureus to rifampicin, quinolones and gentamicin was more than 60.00%. No fungal strains resistant to commonly used clinical drugs such as fluconazole and voriconazole were detected in the old and new ward.

There are certain differences in the distribution and drug resistance of pathogenic bacteria in burn patients from old and new ward, and the multiple drug resistance is serious. Common bacteria and their drug resistance patterns are regularly inspected and diagnosed, so as to determine the appropriate antibiotic regimen and conduct appropriate treatment.