摘要:目的分析开放性 手部及前臂外伤厌氧菌感染患者的临床病原学特征及药敏情况。方法回顾性分析 2015- -2021年53例开放性手部及前臂外伤厌氧菌感染患者的临床特征、实验室指标、病原菌鉴定和药敏试验结果。病原菌鉴定使用基质辅 助激光解吸电离飞行时间质谱( MALDI-TOF MS)方法,并用16S rRNA测序验证。药敏试验采用E-test 法进行。结果53例患者感染类型中1种厌氧菌+1种非厌氧菌感染占52.8%,1种厌氧菌+1种及以上厌氧菌或非厌氧菌感染占88.7%。 共分离 出26种66株厌氧菌,从直接或间接咬伤病例中分离的厌氧菌占总株数的75.8%。23 株非拟杆菌群的革兰阴性厌氧菌最低抑菌浓度(MIC)≤0.5 μg/mL的药物种类为:亚胺培南(22株,占96%)、美罗培南(22株,占96%)、甲硝唑(22株,占96%)、哌拉 西林/他唑巴坦(21株,占91%)、阿莫西林/棒酸(20株,占87%)。结论开放性 手部及前臂外伤的厌氧感染混合感染率高;直接或间接咬伤的患者病原菌复杂;革兰阴性厌氧杆菌引起的感染可选用亚胺培南、美罗培南、甲硝唑及哌拉西林/他唑巴坦 等抗菌药物治疗。
Abstract: Objective To investigate the clinical and pathogenic features and drug sensitivity of anaerobic infection in patients with open injury of hands and forearms. Methods The clinical characteristics, laboratory indexes, and the results of pathogen identification and drug sensitivity test in 53 patients with anaerobic infection caused by the open injury of hands and forearms during 2015 and 2021 were retrospectively analyzed. Pathogens were identified by matrix -assisted laser desorption ionization time-of-flight mass spectrometry ( MALDI-TOF MS) and verified with 16S rRNA sequencing. The drug sensitivity test was performed using the Epsilometric test (E-test). Results Among the 53 patients, 52.8% were infected with one kind of anaerobe and one kind of non -anaerobic bacteria, and 88.7% were infected with one kind of anaerobe and one or more kinds of anaerobe and/ or non-anaerobic bacteria. A total of 26 species and 66 strains of anaerobes were isolated, and 75.8% of strains were isolated from the patients suffered direct or indirect bites. The types of drugs with a minimum inhibitory concentration ( MIC)≤0.5 μg/ mL against 23 strains of Gram-negative anaerobes belonging to the non-Bacteroides group included imipenem ( 96%, 22/23) , meropenem ( 96%，22/23) ，metronidazole ( 96%，22/23) ，piperacillin/ tazobactam (91% , 21/23)，and amoieilin/ clavulanic acid (87%, 20/23). Conclusion The mixed infection rate of anaerobic infection in the open injury of hands and forearms is high. The pathogens in the patients suffered direct or indirect bites are complex. The infections caused by Gram-negative anaerobes can be treated with imipenem, meropenem , metronidazole , piperacillin/ tazobactam and etc.