| OBJECTIVE: To investigate the distribution and antibiotic resistance of conditional pathogens in refractory wounds of extra severe burn-Injured patients in our department,in order to provide guideline for clinical practice of treatment and prevention refractory wounds of extra severe burn-Injured by standardize antibacterial.METHODS: To retrospective analysis the general information of hospitalized116 patients of extra severe burn-Injured with refractory wounds from the First Affiliated Hospital of Guangxi Medical University from November 2012 to October 2019,and the distribution and antibiotic resistance of conditional pathogens in secretion specimens and burn-Injured wound tissue.RESULTS:(1)There were 566 strains of conditional pathogens were isolated.Among them,424 were Gram-negative bacteria(74.91%).The three most Gram-negative bacteria with the highest detection rate were Pseudomonas aeruginosa(190isolates,33.57%),Acinetobacter baumannii(146 isolates,25.80%),and Klebsiella pneunoniae(61 isolates,10.78%).Besides 142 were Gram-positive bacteria(25.09%),and most of them were Staphylococcus aureus(126 strains,22.26%).Among them,there were 62 strains of Methicillin resistant staphylococcus aureus(MRSA 10.96%)and 64 strains of Methicillin sensitive staphylococcus aureus(MSSA 11.31%).(2)In terms of the Gram-negative bacteria,the resistance of Pseudomonas aeruginosa to a number of drugs was low,including Piperacillin/Tazobactam,Cefoperazone/sulbactam,Amikacin,Levofloxacin,Ciprofloxacin.Their drug resistance was 33.16%,46.71%,36.84%,43.68% and 46.84%.However,the resistance to other drugs was high.Antibiotic therapy of Klebsiella pneunoniae infection could obtain a better result by using drugs such as Piperacillin/Tazobactam,Cefoxitin,Amikacin,Meropenem,Imipenem,Tigecycline.The resistance of Acinetobacter baumannii to Tigecycline and Minocycline was very low,but to the other drugs was high.(3)The Staphylococcus aureus had shown no resistance to some kinds of antibiotic like Nitrofurantoin,Linezolid,Vancomycin,Tigecycline and Teicoplanin.Among Staphylococcus aureus,Methicillin sensitive staphylococcus aureus(MSSA)had resistance to amikacin and meropenem was only 9.38%,meanwhile the resistance of Methicillin resistant staphylococcus aureus(MRSA)was 37.10%.And last,the resistance of Staphylococcus aureus to the other antibiotic was higher than 59.68%.CONCLUSION:By making a comprehensive analysis as for the distribution and antibiotic resistance of conditional pathogens in refractory wounds of extra severe burnInjured patients in our department,we can take some action including intervention measures and precision medication in order to control conditional pathogens infection,and cure refractory wounds of extra severe burn-Injured.1.Most of the conditioned pathogens detected from specimen were gramnegative bacteria,accounting for 74.91%.The detected proportion was significantly higher than that of 25.09% of gram-positive bacteria,and the proportion of gram-negative bacteria increased in the past.2.Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus aureus and Klebsiella pneumoniae were the main pathogens causing residual wound infection in the wounds of extra severe burn-Injured patients in our hospital.Therefore,antibiotics sensitive to the above pathogens should be considered in the treatment of clinical experience.3.Pseudomonas aeruginosa,acinetobacter baumannii,klebsiella pneumoniae,the main gram-negative bacteria,have a higher resistance rate to broad-spectrum antibiotics commonly used in the treatment of severe burns,such as cefoperazone/sulbacartan,imipenem,meropenem,etc.In particular,acinetobacter baumannii has achieved a drug resistance rate of more than 90% to most antibiotics.4.Antibiotics with low drug resistance of pseudomonas aeruginosa include piperacillin/tazobactam and amikacin,while acinetobacter baumannii has low drug resistance to tegacycline and minocycline,which is recommended to be used in clinical treatment.5.There is now a considerable number of highly resistant MSSA,and the empirical use of low-sensitivity drugs such as moxifloxacin,penicillin,moxifloxacin,penicillin,erythromycin and clindamycin should be closely monitored when clinically used empirically,and the antibiotic should be adjusted in time when the effect is not good.6.The antibiotic with low drug resistance rate of MRSA is linezolid tegacycline vancomycin tekhoranine,which is recommended for clinical treatment. |
