目的 分析下肢慢性創傷性骨髓炎患者創面細菌培養分布情況，為臨床用藥提供依據。 方法 對2006年1月－2010年12月收治的91例慢性骨髓炎患者創面分泌物細菌培養標本結果進行回顧性調查分析。其中男78例，女13例；年齡5～78歲，平均41.3歲。病程47 d～7個月，平均68.6 d。使用抗生素總療程均＞7 d。 結果 65例創面細菌培養陽性患者共分離出113株病原菌，其中G?菌72株，占63.71%；G+菌41株，占36.28%。藥敏結果顯示，G+菌對常規青霉素類基本耐藥，碳青霉烯類耐藥菌株少見，對萬古霉素耐藥菌株尚未出現。G?菌對青霉素類及頭孢菌素類耐藥較高，對頭孢哌酮－舒巴坦無耐藥。 結論 加強對慢性創傷性骨髓炎患者創面病原菌監測極為必要,對臨床抗生素的合理使用具有一定的指導意義。Objective To analyze the distribution of cultured bacteria from chronic osteomyelitis patients, and provide a basis for clinical medicine. Methods We retrospectively analyzed the bacterial culture results of the secretions from 91 patients with chronic osteomyelitis treated in our hospital from January 2006 to December 2010. Among them, there were 78 males and 13 females aged from 5 to 78 years averaging at (41.3 ± 8.35) years. The duration of the disease ranged from 47 days to more than 7 months, averaging (68.6 ± 14.57) days. The total course of antibiotic-taking was longer than 7 days for all the patients. Results A total of 113 pathogen strains were isolated from 65 secretion samples, including 72 Gram-negative bacteria accounting for 63.71% and 41 gram-positive bacteria accounting for 36.28%. Drug susceptibility results showed basic resistance of Gram-positive bacteria to conventional penicillin, rare resistance to carbapenem, and no resistance to vancomycin. Gram-negative bacteria were basically resistant to penicillin and cephalosporins, but not resistant to cefoperazone-sulbactam. Conclusion Enhancing the monitoring of pathogens for patients with chronic osteomyelitis is extremely necessary for the rational clinical use of antibiotics.
【摘要】 目的 對季也蒙念珠菌感染患者的臨床及微生物學特征進行分析，為臨床診治提供參考。 方法 收集2006年1月-2008年12月病原菌培養為季也蒙念珠菌的10例住院患者資料進行回顧性分析。 結果 季也蒙念珠菌感染患者存在多種基礎疾病，大多數患者（8/10）有易感因素，其中7例使用廣譜抗菌藥物。10例中有8例為深部真菌感染。其臨床表現與感染部位有關，主要累及泌尿道、呼吸道和皮膚軟組織。多數深部感染患者（6/8）在感染前存在同部位細菌感染，部分患者（3/8）在相同部位還可分離出其他真菌。全部季也蒙念珠菌菌株對兩性霉素B敏感，大多數菌株（9/10）對氟康唑敏感。僅1例患者因肺部感染、呼吸衰竭死亡，其余患者經氟康唑、伊曲康唑或特比萘芬等抗真菌藥物治愈。 結論 季也蒙念珠菌感染多發生于有基礎疾病、存在真菌易感因素者，感染部位多為原細菌感染部位，常合并其他細菌或真菌感染。部分菌株對氟康唑和伊曲康唑中敏或耐藥，治療應根據藥敏進行選擇。【Abstract】 Objective To analyze the clinical and microbiologic characters of candida guilliermondii to improve the clinical diagnosis and treatment. Methods The clinical data of 10 patients with candida guilliermondii infection diagnosed in our hospital from January 2006 to December 2008 were retrospectively analyzed. Results All the patients had several underlying conditions; eight patients had predisposing factors and seven patients were prescribed with broad-spectrum antibacterials. Eight patients had deep mycoses, whose clinical manifestation was associated with the infectious sites, mainly involved in urinary tract, respiratory tract and skin-soft tissues. Most deep mycoses (6/8) had prior bacterial infection at the candida guilliermondii infection site; some patients (3/8) had other fungous infection at the same time. All the strains were sensitive to amphotericin B; most fungous strains (9/10) were sensitive to fluconazole. One patient died of pulmonary infection and respiratory failure, and the others were cured by fluconazole, itraconazole or terbinafine. Conclusion Candida guilliermondii infection mainly occurs in patients with underlying conditions and predisposing factors. The infectious sites have prior bacterial infection and bacterial infection or fungous infection at the same time. Since some candida guilliermondii strains were not sensitive to fluconazole and itraconzole, drug sensitive test should be consulted.
