2012年6月~2022年5月某医院烧伤科尿培养情况分析

June 2012~May 2022: A Hospital Analysis of Urine Culture in the Burn Department

摘要: 目的：了解本院烧伤科烧伤病人中段尿检出病原菌分布以及药敏试验结果，以便更好地监测病原菌耐药情况以及为临床用药提供依据。方法：回顾性分析本院2012年6月~2022年5月烧伤科送至检验科的320份尿液标本检出病原菌情况及药敏试验结果。结果：烧伤科患者尿液培养检出的39株病原菌中，革兰阴性菌18株，占46.15%，前4位的革兰阴性菌分别是铜绿假单胞菌(5株，占12.82%)、肺炎克雷伯菌(4株，占10.25%)、鲍曼不动杆菌(4株，占10.25%)、大肠埃希菌(3株，占7.69%)；真菌15株，占38.46%，前2位真菌分别是热带念珠菌(11株，占28.20%)、光滑念珠菌(2株，占5.13%)；革兰阳性菌6株，为屎肠球菌，占15.38%。经Fisher’s确切概率法检验，不同烧伤面积、不同烧伤深度、不同入院月数检出病原菌差异具有统计学意义(P < 0.05)，烧伤面积越大，病原菌检出率越高，检出病原菌种类越复杂，累及体表烧伤面积 ≥ 50%的C组占69.23%，入院月数在1~2月病原菌检出率最高，占51.28%，烧伤深度为II~III度病原菌检出率最高，占51.28%。大肠埃希菌、肺炎克雷伯菌对环丙沙星、头孢他啶耐药率高，铜绿假单胞菌对环丙沙星、庆大霉素耐药率高，鲍曼不动杆菌对亚胺培南、环丙沙星普遍耐药；肠球菌对β-内酰胺类抗生素耐药率较高；热带念珠菌对氟康唑耐药率较高。结论：通过回顾性分析了解烧伤病人尿培养病原菌分布、药敏结果及监测，有助于指导临床合理用药，避免抗生素滥用。

Abstract: Objective: To understand the distribution of pathogenic bacteria and the results of the middle urine test of burn patients in the burn department of our hospital, so as to better monitor the drug resistance of pathogenic bacteria and provide a basis for clinical drug use. Methods: A retrospective analysis was conducted on the detection of pathogenic bacteria and the results of drug sensitivity tests for 320 urine samples sent from the Burn Department to the Clinical Laboratory in our hospital from June 2012 to May 2022. Results: Among 39 pathogens detected in urine culture of burn department, 18 strains of Gram-negative bacteria, accounted for 46.15%, The top four Gram-negative bacteria were Pseudomonas aeruginosa (5 strains, 12.82%), Klebsiella pneumoniae (4 strains, 10.25%), Acinetobacter baumannii (4 strains, 10.25%), Escherichia coli (3 strains, 7.69%). Among the detected pathogens, 15 strains were fungi, accounting for 38.46% of the total. The top two fungi were Candida tropicalis (11 strains, accounting for 28.20%) and Candida glabrata (2 strains, accounting for 5.13%). There were 6 strains of Gram-positive bacteria detected, all Enterococcus faecium, accounting for 15.38% of the total. According to the Fisher’s exact test, statistically significant differences were observed in the detection of pathogenic bacteria among different burn areas, burn depths, and months of hospital admission (P < 0.05). Specifically, the larger the burn area, the higher the detection rate of pathogenic bacteria, and the more complex the types of pathogens detected. Group C, which involved a body surface burn area of ≥50%, accounted for 69.23% of the cases. The highest detection rate of pathogenic bacteria occurred within 1~2 months of hospital admission, accounting for 51.28%. Additionally, the highest detection rate of pathogens was observed in burns of grade II~III, also accounting for 51.28%. Escherichia coli and Klebsiella pneumoniae exhibited high resistance rates to ciprofloxacin and ceftazidime. Pseudomonas aeruginosa showed high resistance rates to ciprofloxacin and gentamicin, while Acinetobacter baumannii generally demonstrated resistance to imipenem and ciprofloxacin. Enterococci had a high resistance rate to β-lactam antibiotics. Candida tropicalis, on the other hand, showed a high resistance rate to fluconazole. Conclusion: Through retrospective analysis, we understood the distribution, drug susceptibility results and monitoring of urinary culture pathogens in burn patients, which is helpful to guide clinical rational drug use and avoid the abuse of antibiotics.