陈欢欢 黄聪聪 何李县 高伟阳 徐云云

[摘要] 目的 研究手外伤缺损皮瓣修复术后切口感染的病原菌分布特征及耐药性，为感染防治提供参考。 方法 选择2019年5月至2020年5月在我院急诊外科行手外伤缺损皮瓣修复术患者158例纳入研究，统计术后切口感染发病率;采集切口感染分泌物，进行病原菌培养和耐药实验，探究手外伤缺损皮瓣修复术后切口感染的病原学及药敏特征。 结果 158例手外伤缺损患者中，皮瓣修复术后并发切口感染59例，感染率為37.34%;其中以大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌和溶血性链球菌为主。大肠埃希菌对环丙沙星、克林霉素及头孢唑林存在高耐药性，但对亚胺培南、庆大霉素无耐药性;铜绿假单胞菌对青霉素G、克林霉素存在高耐药性，但对亚胺培南、万古霉素无耐药性。金黄色葡萄球菌对左氧氟沙星、氨苄西林/舒巴坦存在高耐药性，但对头孢他啶、青霉素G及万古霉素无耐药性;溶血性链球菌对左氧氟沙星、氨苄西林/舒巴坦、克林霉素存在高耐药性，但对环丙沙星、青霉素G无耐药性。 结论 外伤缺损皮瓣修复术后切口感染病原菌以大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌和溶血性链球菌为主，且对亚胺培南、庆大霉素、万古霉素等多种抗菌药物无耐药性，抗感染效果确切。

[关键词] 手外伤缺损;皮瓣修复术;切口感染;病原菌分布;药敏性

[中图分类号] R658.2          [文献标识码] B          [文章编号] 1673-9701（2021）30-0096-04

[Abstract] Objective To study the distribution characteristics and drug resistance of pathogenic bacteria in wound infection after repair of hand trauma defect skin flaps， and to provide reference for infection prevention and treatment. Methods A total of 158 patients who underwent hand trauma defect skin flap repair in the emergency surgery of our hospital from May 2019 to May 2020 were selected and included in the study. The incidence rate of postoperative wound infection was statistically analyzed. The secretions from incision infection were collected， and the pathogen culture and drug resistance experiments were carried out， so as to explore the etiology and drug susceptibility characteristics of wound infection after repair of hand trauma defect skin flaps. Results Among the 158 patients with hand trauma defect， 59 patients were complicated with wound infection after skin flap repair， and the infection rate was 37.34%;among them， the main infections were Escherichia coli， Pseudomonas aeruginosa， Staphylococcus aureus and Streptococcus hemolyticus. Escherichia coli was highly resistant to ciprofloxacin， clindamycin and cefazolin， but not resistant to imipenem and gentamicin; Pseudomonas aeruginosa was highly resistant to penicillin G and clindamycin， but not resistant to imipenem and vancomycin.Staphylococcus aureus was highly resistant to levofloxacin， ampicillin/sulbactam， but not resistant to ceftazidime， penicillin G and vancomycin; Streptococcus hemolyticus was highly resistant to levofloxacin， ampicillin/sulbactam， and clindamycin， but not resistant to ciprofloxacin and penicillin G. Conclusion The pathogens of wound infection after trauma defect skin flaps repair are mainly Escherichia coli， Pseudomonas aeruginosa， Staphylococcus aureus and Streptococcus hemolyticus. They show no resistance to imipenem， gentamicin， vancomycin and other antibacterial drugs， and the anti-infection effects are definite.

[Key words] Hand trauma defect; Skin flaps; Incision infection; Pathogenic distribution; Drug suscpetibility

手外伤皮肤缺损是外科临床较为常见……