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目的 对华西医院入院治疗的1823例汶川地震伤员的感染病原学实验进行分析总结,为完善大型灾难诊治预案提供依据.方法 根据地震伤员感染情况送检培养.细菌鉴定使用全自动细菌鉴定和药敏分析仪,厌氧菌鉴定使用半自动细菌鉴定卡.体外药敏标准以及多药耐药菌表型确证试验参照临床实验室标准化协会(CLSI)2008抗菌药物体外敏感性试验标准规范.结果 1823例入院地震伤员中有病原学证据的感染725例.送检培养的标本中主要包括伤口分泌物(62.1%)和血液(30.0%).地震后1个月地震伤员与地震前1个月普通患者分离的病原菌有明显不同,血培养分离的菌株中,震后1个月地震伤员分离的前5位病原菌依次为:鲍曼不动杆菌(16.7%)、溶血葡萄球菌(16.7%)、大肠埃希菌(12.5%)、肺炎克雷伯菌(12.5%)、热带念珠菌(8.3%);而震前1个月普通患者分离的前5位病原菌依次为:大肠埃希菌(18.2%)、金黄色葡萄球菌(11.4%)、光滑念珠菌(11.4%)、肺炎克雷伯菌(11.4%)、表皮葡萄球菌(9.1%).地震伤员分离的鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌与非地震住院患者分离出的同种病原菌相比,两者分离菌的体外药敏率有明显变化.地震后1个月地震伤员中耐甲氧西林金黄色葡萄球菌分离率低于震前普通患者;产超广谱β-内酰胺酶的大肠埃希菌、肺炎克雷伯菌和产酸克雷伯菌的分离率高于震前普通患者(均P<0.05),而多重耐药铜绿假单胞菌和多重耐药鲍曼不动杆菌分离率震前震后差异无统计学意义(P>0.05).结论 自然灾害发生后伤员出现多重感染往往不可避免,加上各种多重耐药菌的出现,对常规院内治疗提出挑战,因此总结地震灾害后病原菌谱和耐药谱的变化,可为灾害的应急处理提供依据.

Objective To analyze the etiology of infections in the wounded victims of Wenchuan Earthquake. Methods 2135 smears of secretion were made from 1823 hospitalized wounded victims of Wenchuan Earthquake to detect the pathogens. Specimens were delivered to be cultured. The bacteria thus obtained were identified. Drug sensitivity test was conducted. Results 2002 specimens,1243 specimens of secretion (62.1% ),600 blood specimens (30.0%),102 specimens of pus or secretion of respiratory tract (5.1%),45 specimens from catheter (2.2%),and 12 urine specimens (0.5%). Pathogens were found in 725 cases. The top five pathogenic bacteria isolated within 1 month after the quake were Acinetobacter baumannii(16.7%),Staphylococcus haemolyticus (16.7%),Escherichia coli (12.5%),Klebsiella pneumoniae (12.5%),and Candida tropicalis (8.3%),quite different from the pathogen spectrum of the common in-patients within one month before the quake: Escherichia coli (18.2%),Staphylococcus aureus (11.4%),Candida glabrata (11.4%),Klebsiella pneumoniae (11.4%) and Staphylococcus epidermidis (9.1%). The isolation rate of methicillin resistant Staphylococcus aureus after the earthquake was significantly lower,and the isolation rates of extended spectrum β-lactamase-producing Escherichia coli,Klebsiella pneumoniae,and Klebsiella oxytoca were all significantly higher than those from the common surgical patients before the quake (all P < 0.05). There were not significant differences in the isolation rates of multi-drug resistant Pseudomonas alcaligenes and Acinetobacter baumannii before and after the quake. Conclusion Infection is frequent after natural disasters. It is necessary to summarize the changes of spectrum of pathogens and drug-resistant spectrum.