Dissemond J, Schmid E N, Esser S, Witthoff M, Goos M
Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Essen.
Hautarzt. 2004 Mar;55(3):280-8. doi: 10.1007/s00105-004-0697-4.
In this retrospective investigation, we documented the bacterial colonization of 79 patients with chronic wounds, who had been treated between January 2002 and May 2003 in an outpatient wound healing clinic of a university dermatology program. We isolated 106 facultative pathogenic bacterial strains of which 56 were Staphylococcus aureus, 19 Pseudomonas aeruginosa, 11 Escherichia coli, 4 Proteus mirabilis, 4 Enterobacter cloacae, 2 Serratia marcescens, 2 Streptococcus group G und 8 further species. 68 of these bacterial strains were gram-positive and 46 gram-negative. Moreover we identified one patient with Candida parapsilosis. Therefore, 70.8% of all patients showed Staphylococcus aureus in their chronic wounds. Determination of the specific resistances showed 17 patients to be colonized with oxacillin- resistant Staphylococcus aureus (ORSA) strain; this corresponds to 21.5% of all patients. Consequently, 30.4% of all Staphylococcus aureus isolates were ORSA strains. All of the ORSA isolates were sensitive to vancomycin. Sensitivity to tetracycline was documented in 15, to amikacin in 13, to clindamycin in 7, to gentamicin and erythromycin in 6 of the ORSA-positive patients. In the case of trimethoprim/sulfamethoxazole, 10 were sensitive and 3 were intermediate in sensitivity. Beside the obligate resistance to oxacillin, penicillin G, ampicillin, cefuroxime and imipenem, none of the ORSA was sensitive to ofloxacin. The results of our investigations demonstrate the actual spectrum of bacterial colonization in chronic wounds of patients in an university dermatologic wound clinic and underline the growing problem of ORSA.
在这项回顾性研究中，我们记录了2002年1月至2003年5月期间在一所大学皮肤科门诊伤口愈合诊所接受治疗的79例慢性伤口患者的细菌定植情况。我们分离出106株兼性致病菌株，其中56株为金黄色葡萄球菌、19株铜绿假单胞菌、11株大肠杆菌、4株奇异变形杆菌、4株阴沟肠杆菌、2株粘质沙雷氏菌、2株G群链球菌以及8种其他菌株。这些菌株中68株为革兰氏阳性菌，46株为革兰氏阴性菌。此外，我们还鉴定出1例近平滑念珠菌感染患者。因此，所有患者中有70.8%的慢性伤口中存在金黄色葡萄球菌。特定耐药性测定显示，17例患者的伤口被耐氧西林金黄色葡萄球菌（ORSA）菌株定植；这相当于所有患者的21.5%。因此，所有金黄色葡萄球菌分离株中有30.4%为ORSA菌株。所有ORSA分离株对万古霉素敏感。在ORSA阳性患者中，15例对四环素敏感，13例对阿米卡星敏感，7例对克林霉素敏感，6例对庆大霉素和红霉素敏感。对于甲氧苄啶/磺胺甲恶唑，10例敏感，3例中度敏感。除了对氧西林、青霉素G、氨苄西林、头孢呋辛和亚胺培南的固有耐药性外，没有一株ORSA对氧氟沙星敏感。我们的研究结果显示了一所大学皮肤科伤口诊所中患者慢性伤口细菌定植的实际情况，并突显了ORSA日益严重的问题。
