Basu Somprakas, Ramchuran Panray Tetraj, Bali Singh Tej, Gulati Anil K, Shukla Vijay K
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Ostomy Wound Manage. 2009 Jan;55(1):14-20.
Indiscriminate use of antibiotics for infected chronic wounds is a global problem that may contribute to delayed healing and the development of drug-resistant micro-organisms. A prospective, descriptive cohort study of 50 male and female outpatients (mean age 52.50 [+/- 14.84] years, range 18-90) with 52 chronic wounds was conducted to investigate the microbiological profile and prevalence of drug-resistant strains in chronic nonhealing wounds to develop an evidence-based approach to antibiotic therapy until drug sensitivity reports are available. Mean wound duration was 8.23 (+/- 12.35) months (range 1.5-72), average wound size was 29.70 (+/- 37.83) cm, and most patients had a lower extremity wound and diabetes mellitus (n = 20). Pus and tissue samples were cultured and tested. Most (45) wounds contained a single organism and nine different genera were isolated. Of those, 39 were Gram-negative and 11 were Gram-positive (z = 5.50, P = <0.001). The most common organisms were Pseudomonas (21 wounds) and Escherichia coli (eight wounds). Pseudomonas aeruginosa was more common in patients with diabetes mellitus, in lower extremity ulcers, and in ulcers >20 cm2 (z-test, P <0.05). The presence of two organisms was more commonly observed in postsurgical/traumatic wounds. Ten (10) out of 55 pathogens (18.18%) isolated were drug-resistant, including Pseudomonas (seven), methicillin-resistant Staphylococcus aureus (one), and extended-spectrum beta lactamase (two--E. coli and Citrobacter). Most (70%) drug-resistant pathogens were obtained from persons with diabetes mellitus. Overall sensitivity to piperacillin and tazobactum combination was high. Because the prevalence of monomicrobial flora in chronic wounds is high, if a wound infection is suspected, empiric therapy should target the most prevalent flora. The high rate of drug-resistant Pseudomonas and MRSA strains should discourage antibiotic use in chronic ulcers before obtaining culture results.
对感染性慢性伤口滥用抗生素是一个全球性问题，可能会导致愈合延迟以及耐药微生物的产生。我们对50名患有52处慢性伤口的门诊患者（25名男性和25名女性，平均年龄52.50[±14.84]岁，年龄范围18 - 90岁）进行了一项前瞻性描述性队列研究，以调查慢性不愈合伤口的微生物学特征和耐药菌株的流行情况，从而在获得药敏报告之前制定基于证据的抗生素治疗方法。伤口平均持续时间为8.23（±12.35）个月（范围1.5 - 72个月），平均伤口面积为29.70（±37.83）平方厘米，大多数患者有下肢伤口且患有糖尿病（n = 20）。采集脓液和组织样本进行培养和检测。大多数（45处）伤口含有单一微生物，共分离出9个不同的菌属。其中，39个为革兰氏阴性菌，11个为革兰氏阳性菌（z = 5.50，P = <0.001）。最常见的微生物是假单胞菌（21处伤口）和大肠杆菌（8处伤口）。铜绿假单胞菌在糖尿病患者、下肢溃疡患者以及面积>20平方厘米的溃疡患者中更为常见（z检验，P <0.05）。在手术/创伤后伤口中更常观察到存在两种微生物的情况。分离出的55种病原体中有10种（18.18%）具有耐药性，包括假单胞菌（7种）、耐甲氧西林金黄色葡萄球菌（1种）和超广谱β内酰胺酶（2种——大肠杆菌和柠檬酸杆菌）。大多数（70%）耐药病原体来自糖尿病患者。对哌拉西林和他唑巴坦联合用药的总体敏感性较高。由于慢性伤口中单一微生物菌群的流行率较高，因此如果怀疑伤口感染，经验性治疗应针对最常见的菌群。在获得培养结果之前，耐药假单胞菌和耐甲氧西林金黄色葡萄球菌菌株的高发生率应避免在慢性溃疡中使用抗生素。
