| Objective:The formation and healing of chronic wound surface are affected by various factors,which has gradually become a difficult problem in medical treatment.Among various factors,infection plays an increasingly obvious role in preventing wound repair,and the difficulty in healing of infected wounds is mainly caused by continuous and severe inflammatory reactions.Therefore,effective anti-infection treatment is particularly important.This research through the retrospective analysis of the first affiliated hospital of Guangxi medical university burn plastic surgery department between January 2012 and December2019 hospital clinical data of patients with chronic wounds,and to investigate the clinical bacteriological characteristics and drug sensitivity results of chronic wounds,in order to understand the changes in the bacterial spectrum of various chronic wounds in recent years,regularly monitor and intervene the changes of pathogen resistance,so as to provide clinical basis for the prevention and treatment of chronic wounds and the rational use of antimicrobial agents.Methods:To analyze the case data of 1484 patients with chronic wounds admitted to the first affiliated hospital of Guangxi medical university for Burn Plastic surgery from January 2012 to December 2019.Including the basic information(sex,age),hospitalization days,etiology,position,specimens,bacteriology and drug susceptibility.According to the different causes of wound formation,this paper divided them into 10 categories:1.Trauma wound 2.Burn wound 3.Diabetes wound 4.Infection wound 5.Cancer wound 6.Insect and snake bite wound 7.Arteriovenous ulcer wound 8.Scar ulcer wound 9.Stress wound 10.Iatrogenic wound.A simple statistical analysis was made on the basic data and drug resistance of chronic wounds to understand the bacteriological changes of various chronic wounds.Results:1.Among the 1484 hospitalized patients with chronic wounds who met the inclusion criteria,the ratio of male to female was 2.13:1,the average age was51.16 years old,and the average hospitalization day was 20.03 days.A total of3,766 specimens were collected from 1,484 hospitalized patients with chronic wounds for eight years,and 1,576 strains of pathogenic bacteria were isolated and cultured.The positive rate of bacterial culture was 41.85%.The main sources of bacterial species were wound secretions(62.12%,979 strains)and scab tissue or granulation tissue(498 strains,31.60%).Moreover,there was a statistically significant difference in the rate of specimen examination among patients with chronic wounds within 8 years(x~2=51.177,P<0.005).2.Among the 1576 pathogen strains,856(54.32%)were gram-negative,534(33.88%)were gram-positive,and 186(11.80%)were fungus.And the top six pathogens were staphylococcus aureus(226 strains),pseudomonas aeruginosa(196 strains),escherichia coli(165 strains),acinetobacter baumannii(115 strains),staphylococcus epidermoides(97 strains)and klebsiella pneumoniae(90 strains).There was no statistically significant difference in the distribution of gram-negative bacteria(x~2=0.843,P>0.05)and fungi(x~2=5.326,P>0.05),but the gram-positive bacteria(x~2=11.613,P<0.05).However,There was significant difference in the distribution of bacteria and fungi(x~2=15.634,P<0.05),gram-negative bacteria and fungi(x~2=19.644,P<0.05),but the gram-negative bacteria and gram-positive bacteria(x~2=11.369,P>0.05),gram-positive bacteria and fungi(x~2=8.666,P>0.05).3.According to different etiology,the main wound types in the 10categories were infection(312 cases),trauma(210 cases),diabetes(162 cases),stress(156 cases)and burn.(138 cases).The common lower extremity and wound infection pathogens are mainly gram-negative bacteria.Moreover,there were significant differences in the location of chronic wound patients within 8years(x~2=1545.16,P<0.05).Staphylococcus aureus is commonly seen in infectious wounds and traumatic wounds,while pseudomonas aeruginosa and escherichia coli are highly detected in diabetic wounds and pressure wounds.In addition,the number of cases of various types of chronic wounds in the past 8years was statistically significant(x~2=25.678,P<0.05).4.Among the main gram-positive bacteria,the common strains are staphylococcus aureus and staphylococcus epidermidis,which are highly sensitive to vancomycin,tegacycline,linezolid and teicolanine,but the most of the aminoglycosides,lactamides and quinolones.Enterococcus faecalis is sensitive to antibiotics.Drug resistance was more serious in the 4 years.And the number and drug resistance of methicillin-resistant staphylococcus aureus(MRSA)increased.In addition,the drug resistance rate of staphylococcus aureus to amikacin(P=0.006)and cotrimoxazole(P=0.047)increased,and the statistical difference was significant.5.Among the major gram-negative bacteria,the drug resistance of acinetobacter baumannii was the most serious except tigacycline(0.37%)and minocycline(13.60%).The sensitivity of pseudomonas aeruginosa to most cephalosporin antibiotics,ampicillin,furantoin and trimoxazole was poor,and the sensitivity of other antibiotics was better.Escherichia coli was slightly more sensitive to antibiotics than acinetobacter baumannii and pseudomonas aeruginosa.Compared with the previous 4 years,the drug resistance rate of the main dominant gram-negative bacteria to antibacterial drugs generally showed an increasing trend in the next 4 years.In addition,the drug resistance rate of pseudomonas aeruginosa to amikacin(P=0.014),levofloxacin(P=0.008)and piperacillin/tazobactam(P=0.023)decreased slightly and the difference was statistically significant.Conclusion:In the prevention and treatment of chronic wound infection,although some bacteria have achieved good results in detection rate and drug resistance rate,the current situation of chronic wound infection resistance in medicine is still not optimistic,and it is still necessary to integrate multidisciplinary cooperation to intervene to prevent further aggravation of drug resistance.So against the serious drug resistance,the anti-infection treatment of chronic wounds should be more standardized.The treatment of wound should be correct,timely and standard.And we need to improve the rate of wound specimen submission and detection,establish and improve the antimicrobial spectrum and antimicrobial drug use guidelines of our family,regularly monitor and intervene the change of pathogen resistance.In addition,We also should consider the wound site and etiological factors of patients,to avoid using some empirical single or one kind of antibiotics and adjust antimicrobial agents timely according to drug sensitivity.So as to reduce the production,promote wound healing,reduce the average hospital stay,and reduce the pain and financial burden of patients,it is important to control the infection effectively.1.The incidence of chronic wound is higher in males than in females,mostly in the elderly.The source of bacterial strain detection mainly lies in wound secretions and tissue or granulation tissue under wound scab.2.Among the pathogenic bacteria of infection in patients with chronic wounds,gram-negative bacteria were the main pathogens,among which the highest detection rate was pseudomonas aeruginosa,escherichia coli and acinetobacter baumannii.The most common gram-positive bacteria were staphylococcus aureus.3.The bacteria species detected in the wound surface types caused by different etiology and different sites were also different.The lower limbs were the sites with high incidence of wound surface and the detected bacteria were mainly gram-negative bacteria.4.Among all kinds of wound surface bacteria detected,staphylococcus aureus was mainly found in infectious wound surface and traumatic wound surface,while pseudomonas aeruginosa and escherichia coli were highly detected in diabetic wound surface and pressure wound surface.5.Anti-infection treatment of gram-positive bacteria should be mainly targeted at staphylococcus aureus,which has good sensitivity to vancomycin,linezolid,teicolanine and tigacycline,and can be used clinically.6.Gram-negative bacteria maintain high drug resistance to antimicrobial agents,and acinetobacter baumannii’s drug resistance is the most serious problem(except tigacycline and minocycline),which should be paid attention to.As the main gram-negative bacteria,pseudomonas aeruginosa should choose appropriate antibiotics as targeted or empirical drugs in clinical anti-infection,such as cefoperazone/sulbactam,carbapenems and other antibiotics. |
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