Silva Víctor, Marcoleta Alicia, Silva Viviana, Flores Dángelo, Aparicio Teresa, Aburto Isabel, Latrach Cecilia, Febré Naldy
Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Mayor, Santiago, Chile.
Fundación Instituto Nacional de Heridas (FINH), Chile.
Rev Chilena Infectol. 2018 Apr;35(2):155-162. doi: 10.4067/s0716-10182018000200155.
Chronic wounds are considered a public health problem that may be complicated by bacterial infections, mainly caused by resistant strains.
To study the bacteria prevalence and antimicrobial susceptibility in samples from adult patients with chronic wounds.
Patients treated at National Institute of Wounds Foundation between May and July 2014, with chronic ulcers in lower extremities with clinical inflammatory signs were recluted. Samples were cultured in aerobic and anaerobic atmosphere and species identification was performed by API (Biomerieux) galleries. The in vitro susceptibility was evaluated according to the Kirby Bauer method.
From 73 patients, 46 had infected wounds most of them were venous ulcers (33) with prevalence in polymicrobial infections and 10 with foot-diabetes ulcers with prevalence in monomicrobial infections (p ≤ 0.05). Sixty-eight strains were isolated and Enterobacteriaceae were predominant in monomicrobial infection (p ≤ 0.05) and the other groups were slightly higher in polymicrobial infection. The main species were Staphylococcus aureus (24%) followed by P. aeruginosa (18%). Fifty strains (77%) were resistant or multi-resistance. We emphasize resistance of S. aureus to ciprofloxacin (50%) and cefoxitin (37.5%), thus identifying resistance to methicillin in the community (CA-SAMR), all of which are sensitive to cotrimoxazole. Enterobacteria showed sensitivity to amikacin (95.5%), P. aeruginosa showed resistance to ciprofloxacin (33.3%) with high sensitivity to gentamicin (91.7%) and amikacin (83.3%), while Acinetobacter spp showed resistance to ciprofloxacin and ceftazidime in 60%, with 100% sensitivity to imipenem. 50% Streptococcus β hemolytic showed resistance to clindamycin and penicillin.
These data provide epidemiological information on chronic wound infections, representing support for diagnosis, treatment and management of this pathology.
慢性伤口被视为一个公共卫生问题，可能会因细菌感染而复杂化，主要由耐药菌株引起。
研究成年慢性伤口患者样本中的细菌流行情况及抗菌药敏性。
招募2014年5月至7月在国家伤口基金会接受治疗的、患有下肢慢性溃疡且有临床炎症体征的患者。样本在需氧和厌氧环境中培养，并通过API（生物梅里埃）鉴定板进行菌种鉴定。根据 Kirby Bauer 方法评估体外药敏性。
73例患者中，46例伤口感染，其中大多数为静脉溃疡（33例），多为混合菌感染，10例为糖尿病足溃疡，多为单一菌感染（p≤0.05）。分离出68株菌株，肠杆菌科在单一菌感染中占主导（p≤0.05），在混合菌感染的其他菌群中略高。主要菌种为金黄色葡萄球菌（24%），其次是铜绿假单胞菌（18%）。50株（77%）耐药或多重耐药。我们强调金黄色葡萄球菌对环丙沙星（50%）和头孢西丁（37.5%）耐药，从而确定社区获得性耐甲氧西林金黄色葡萄球菌（CA-SAMR），所有这些菌株对复方新诺明敏感。肠杆菌对阿米卡星敏感（95.5%），铜绿假单胞菌对环丙沙星耐药（33.3%），对庆大霉素（91.7%）和阿米卡星高度敏感（83.3%），而不动杆菌属对环丙沙星和头孢他啶耐药率为60%，对亚胺培南敏感率为100%。50%的β溶血性链球菌对克林霉素和青霉素耐药。
这些数据提供了慢性伤口感染的流行病学信息，为该疾病病理学的诊断、治疗和管理提供了支持。
