皮肤创面多重耐药菌感染的菌群分布与耐药性分析OA
Distribution and drug resistance analysis of bacterial flora in patients with multidrug-resist-ant organism infections in skin wounds
目的 研究皮肤内科住院患者皮肤创面多重耐药菌感染的菌群分布和耐药情况,并探讨预防和降低皮肤创面多重耐药感染的护理对策.方法 通过院内医院感染管理系统收集2020年1月至2025年4月在中国医学科学院皮肤病医院皮肤内科住院的149例皮肤创面为多重耐药菌感染患者的临床数据,对患者临床资料、皮肤病种类、病原菌分布、取材部位、耐药情况等进行回顾性分析.结果 149例患者中,按疾病种类分类,病例数量位于前三的是天疱疮55例(36.9％)、大疱性类天疱疮25例(16.8％)、蕈样肉芽肿13例(8.7％).共培养161株多重耐药菌,其中革兰氏阳性菌109株(67.7％),主要为耐甲氧西林金黄色葡萄球菌(MRSA)、多重耐药表皮葡萄球菌、多重耐药溶血性葡萄球菌等;革兰氏阴性菌52株(32.3％),主要为多重耐药肺炎克雷伯菌、多重耐药大肠埃希菌、多重耐药奇异变形杆菌等.取材部位来自四肢(72株,44.7％)最多,其次为躯干(55株,34.2％)、头面颈(11株,6.8％).MRSA对青霉素、苯唑西林、克林霉素耐药率高,分别为98.8％、85.4％、59.8％;多重耐药表皮葡萄球菌对青霉素、苯唑西林、红霉素耐药率高,分别为94.4％、83.3％、66.7％;多重耐药肺炎克雷伯菌和大肠埃希菌对头孢曲松钠、头孢唑林耐药率高,分别为88.2％、82.4％、100％和100％.结论 皮肤内科住院患者皮肤创面发生多重耐药感染主要为天疱疮、大疱性类天疱疮、蕈样肉芽肿等容易导致皮肤屏障受损的疾病.皮肤创面多重耐药的革兰氏阳性菌以MRSA、表皮葡萄球菌居多,革兰氏阴性菌以肺炎克雷伯杆菌、大肠埃希菌为主,多重耐药菌发生部位以四肢、躯干居多,革兰氏阳性多重耐药菌对青霉素、苯唑西林、克林霉素、红霉素等耐药率较高,革兰氏阴性多重耐药菌对头孢曲松钠、头孢唑林、呋喃妥因等耐药率较高.
Objective To investigate the distribution and drug resistance profiles of multidrug-resistant organisms(MDROs)in skin wounds of inpatients in the Department of Dermatology,and to explore corresponding nursing strategies for prevention and control.Methods Clinical data of 149 inpatients with MDRO-infected skin wounds were retrospectively collected from the Hospital of Dermatology,Chinese Academy of Medical Sciences,between January 2020 and April 2025.Data were extracted via the hospital's nosocomial infection management system.Demographics,under-lying dermatoses,pathogen distribution,sampling sites,and antimicrobial susceptibility patterns were analyzed.Results Among the 149 patients,pemphigus(55 cases,36.9％),bullous pem-phigoid(25 cases,16.8％),and mycosis fungoides(13 cases,8.7％)were the most prevalent conditions.A total of 161 MDRO strains were isolated,including 109(67.7％)Gram-positive bacteria,primarily methicillin-resistant Staphylococcus aureus(MRSA),multidrug-resistant Staph-ylococcus epidermidis,and multidrug-resistant Staphylococcus haemolyticus;and 52(32.3％)Gram-negative bacteria,predominantly multidrug-resistant Klebsiella pneumoniae,Escherichia coli,and Proteus mirabilis.The most common sampling sites were the limbs(72 cases,44.7％),fol-lowed by the trunk(55 cases,34.2％)and the head,face,and neck(11 cases,6.8％).MR-SA showed high resistance rates to penicillin(98.8％),oxacillin(85.4％),and clindamycin(59.8％).Multidrug-resistant S.epidermidis exhibited high resistance rates to penicillin(94.4％),oxacillin(83.3％),and erythromycin(66.7％).Multidrug-resistant K.pneumoniae and E.coli showed high resistance rates against ceftriaxone(88.2％and 100％,respectively)and cefazolin(82.4％and 100％,respectively).Conclusions MDRO infections in dermatology inpatients primarily affect patients with compromised skin barrier,particularly those with pemphi-gus,bullous pemphigoid,and mycosis fungoides.The predominant Gram-positive MDROs are MRSA and S.epidermidis,while the predominant Gram-negative MDROs are K.pneumoniae and E.coli.The most common sites of MDRO infections are the limbs and trunk.Gram-positive MDROs demonstrate high resistance rates to penicillin,oxacillin,clindamycin,and erythromycin,whereas Gram-negative MDROs show high resistance rates to ceftriaxone,cefazolin,and nitro-furantoin.
赵小丹;宗岩;周旋
中国医学科学院皮肤病医院,江苏 南京 210009中国医学科学院皮肤病医院,江苏 南京 210009中国医学科学院皮肤病医院,江苏 南京 210009
皮肤创面多重耐药菌菌群分布耐药分析护理对策
skin woundsmultidrug-resistant organismspathogen distributiondrug re-sistance analysisnursing strategies
《皮肤性病诊疗学杂志》 2026 (5)
337-342,6
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