| Objective:Through the retrospective analysis of the pathogens isolated from SSTI(skin and soft tissue infection)in dermatology inpatients in our hospital from 2015 to 2020,to understand the clinical distribution of the main pathogens of skin and soft tissue infection in dermatology inpatients in this region and their resistance to antibiotics,so as to provide reference basis for the clinical treatment of skin and soft tissue infection and the rational selection of antibiotics.Methods:The basic clinical data of SSTI inpatients in the dermatology ward of our hospital from November 2015 to November 2020 were collected by retrospective investigation.The results of bacterial culture,isolation,identification and drug sensitivity test of wound secretion and pus samples were collected,and the clinical distribution and drug resistance rate of main pathogens were analyzed.Excel and SPSS 24.0 statistical software were used for statistical analysis.Results:1.From November 2015 to November 2020,713 patients with skin and soft tissue infection met the inclusion criteria,including 459 males(64.38%)and 254 females(35.62%).The average age was(53.39 ± 20.53)years.The elderly patients(> 65 years)accounted for61.43%.The top three types of SSTI were dermatitis and eczema with infection in 218 cases(30.58%),autoimmune blister disease with infection in 102 cases(14.31%)and erysipelas in43 cases(6.03%).Among 265 patients(37.17%)with SSTI,diabetes accounted for the most(35%).2.A total of 808 strains(44 species)of pathogens were detected,including 609 strains of gram-positive(G +)bacteria,accounting for 75.37%;182 strains of gram-negative(G-)bacteria,accounting for 22.52%;17 strains of fungi,accounting for 2.10%.The top three strains of G + bacteria were: 385 strains of Staphylococcus aureus,accounting for 47.65%;92strains of Staphylococcus epidermidis,accounting for 11.39%;37 strains of Staphylococcus haemolyticus,accounting for 4.58%.The detection rate of MRSA(methicillin resistant Staphylococcus aureus)was 9.28%,and that of MRCNS(methicillin resistant coagulase negative Staphylococcus)was 11.63%.The top three strains of G-bacteria were 63 strains of Escherichia coli,accounting for 7.80%;26 strains of Enterobacter cloacae,accounting for3.22%;23 strains of Klebsiella pneumoniae,accounting for 2.85%.Among them,ESBL(ultra broad spectrum is produced β-The detection rate of Enterobacter lactamase)was 3.34%.3.The drug sensitivity test of the three G + bacteria with the highest detection rate to antibiotics: Staphylococcus aureus has low sensitivity to penicillin(drug resistance rate87.99%),erythromycin(drug resistance rate 74.15%)and clindamycin(drug resistance rate71.28%);The sensitivity to rifampicin(resistance rate 1.57%)and quinuptine / dafuptine(resistance rate 1.04%)was high.The drug resistance rates of penicillin(72.68%)and staphylococcin(59.96%)were lower than those of penicillin(59.96%);It was highly sensitive to gentamicin(resistance rate 7.61%)and to rifampicin(resistance rate 0.00%).Staphylococcus haemolyticus was less sensitive to erythromycin(94.59%),penicillin(91.89%),oxacillin(89.19%),cefoxitin(85.29%),clindamycin(78.38%),levofloxacin(72.97%)and ciprofloxacin(72.97%);The sensitivity to rifampicin(drug resistance rate2.70%)was high.Staphylococcus epidermidis and Staphylococcus haemolyticus were all sensitive to quinuptine / dafuptine(drug resistance rate 0.00%).The three G + bacteria with the highest detection rates of Staphylococcus aureus,Staphylococcus epidermidis and Staphylococcus haemolyticus were sensitive to vancomycin(resistance rate 0.00%),tegacyclin(resistance rate 0.00%)and linezolid(resistance rate 0.00%).4.The drug sensitivity test of the three G-bacteria with the highest detection rate to antibiotics: Escherichia coli has low sensitivity to cefazolin(drug resistance rate 86.36%),ampicillin(drug resistance rate 84.09%)and levofloxacin(drug resistance rate 61.90%);The sensitivity to cefepime(resistance rate 7.94%),imipenem(resistance rate 3.17%),amikacin(resistance rate 4.76%),piperacillin / tazobactam(resistance rate 1.59%)and fosfomycin(resistance rate 2.27%)was high;They were all sensitive to meropenem(drug resistance rate0.00%).Enterobacter cloacae was resistant to cefazolin(100.00%)and ampicillin(100.00%);The sensitivity to cefoxitin(drug resistance rate 88.89%)and cefuroxime(drug resistance rate86.67%)was low;The sensitivity to cefepime(drug resistance rate 7.69%)and amikacin(drug resistance rate 3.85%)was high;Enterobacter cloacae was sensitive to levofloxacin(resistance rate 0.00%),imipenem(resistance rate 0.00%),piperacillin / tazobactam(resistance rate 0.00%),meropenem(resistance rate 0.00%),cefotaxime(resistance rate0.00%)and ceftazidime(resistance rate 00.00%).Klebsiella pneumoniae was less sensitive to cefuroxime(90.00%),levofloxacin(78.26%),gentamicin(60.00%),cefazolin(60.00%),piperacillin / tazobactam(78.26%),fosfomycin(65.00%),fufangxinnaoming(91.30%)and ceftazidime(65.00%);All patients were resistant to ampicillin(100.00%);Klebsiella pneumoniae was sensitive to imipenem(drug resistance rate 0.00%),meropenem(drug resistance rate 0.00%),cefotaxime(drug resistance rate 0.00%)and aztreonam(drug resistance rate 0.00%).5.The detection rates of MRSA in Staphylococcus aureus isolated from SSTI inpatients within 5 years were 15.69%,21.31%,14.46%,22.58% and 25.00% respectively,which showed an increasing trend year by year.The resistance rate of MRSA to tetracycline,cefoxitin,oxacillin,ciprofloxacin,levofloxacin and compound sulfamethoxazole was significantly higher than that of MSSA(methicillin sensitive Staphylococcus aureus)(P <0.05).The resistance rate of mrcns to levofloxacin,cefoxitin,penicillin,ciprofloxacin,erythromycin,oxacillin and clindamycin was significantly higher than that of mscns(methicillin sensitive coagulase negative Staphylococcus)(P < 0.05).Conclusion:1.The three most common types of SSTI in dermatology inpatients in this region are dermatitis and eczema with infection,autoimmune blister disease with infection and erysipelas;SSTI is mainly elderly,and the incidence rate of male is higher than that of female.The most common complication is diabetes.2.The pathogen of SSTI in dermatological inpatients in this area is still mainly G +bacteria,and the pathogen with the highest detection rate is Staphylococcus aureus(47.65%).The detection rate of MRSA in all strains was(9.28%),which was not higher than the national average level(29.4%),but the proportion of MRSA in Staphylococcus aureus increased year by year.The detection rate of MRCNS in all strains was(11.63%);The drug resistance of MRCNS is serious,which should be paid great attention in clinic.3.Influence of common G + bacteria of SSTI in dermatology inpatients in this region on Basicβ-The resistance rates of lactam antibiotics(penicillin),macrolide antibiotics(erythromycin)and lincomycin antibiotics(clindamycin)are high,so they are not suitable for empirical treatment of SSTI;Vancomycin,linezolid and tegacyclin can be used in the treatment of multidrug-resistant G + bacterial infection.The resistance rate of common G-bacteria to the first and second generation cephalosporins and ampicillin is high,so it is not suitable for empirical drugs;Imipenem and meropenem can be used in the treatment of multidrug-resistant g-bacterial infection.4.For the treatment of skin and soft tissue infection,we should timely and accurately understand the bacterial culture results and drug resistance of wound secretion or pus samples of patients with skin and soft tissue infection,and more reasonably select the corresponding antibiotics for treatment,so as to shorten the course of treatment,cure patients and slow down the production of drug-resistant strains. |
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