Etiological Characteristics Of Skin And Skin-soft Tissue Infections And The Causes Of Wound Difficult Healing

ObjectivesTo understand:1. distribution and drug sensitivity of pathogenic bacteria in acute wounds and chronic wounds; 2 distribution and drug sensitivity of pathogenic bacteria in acute wounds or chronic wounds; 3. the causes of wound difficult healing; 4. distribution and drug sensitivity of pathogenic bacteria in diabetic foots with infection. It was in order to guide the clinical application of antibiotics, reduce the production of drug resistant bacteria, and provide a theoretical basis for the empirical use of antibiotics. At the same time, it causes the clinical value on search for the cause of wound difficult healing and the choice of treatment method in the process of the diagnosis and treatment of chronic wound, to improve the cure rate of the wound. Contents and MethodsFrom January 2014 to January 2016, 143 patients with acute skin and skin-soft tissue infections and 117 patients with chronic wounds were collected from Tianjin People's Hospital. Whose the pus or wound secretion were collected. Bacterial culture and identification were carried out. The major pathogens susceptibility agents were tested. Some patients with chronic wounds were underwent imaging examination, pathological examination and laboratory tests. The laboratory tests measured the white blood cell count, the percentage of neutrophils and the level of fasting blood glucose. SPSS17.0 statistical software for data analysis. Results1. The average age of the patients with acute skin and skin-soft tissue infections was 46.87 years old. The average age of the patients with chronic wounds was 58.44 years old. The age of chronic wounds is greater than the age of acute wounds. Skin and skin-soft tissue infections was easy to occur in men. The best site of skin and skin-soft tissue infections was the lower limb, especially the foot.2. 86 strains of pathogenic bacteria were isolated from 143 cases of acute skin and skin-soft tissue infections. The bacterial detection rate was 60.14%. All were single infection. Among them, the gram positive bacteria accounted for 62.79% and the gram-negative bacteria accounted for 37.21%. Staphylococcus aureus was the main pathogenic bacteria, accounting for 30.23%.In young people, middle-aged person and old person, the bacterial detection rate in acute skin and skin-soft tissue infections had no significant difference(P>0.05). Gram positive bacteria accounted for absolute advantage in young patients(77.50%) and gram negative bacteria were dominant in elderly patients(53.85%). The difference was statistically significant(P<0.05).3. 74 strains of pathogenic bacteria were isolated from 61 cases of chronic wounds. The bacterial detection rate was 88.52%. The mixed infection rate was 31.19%. Gram positive bacteria accounted for 38.64%. Gram negative bacteria accounted for 54.55%. Fungi accounted for 5.41%. Pseudomonas aeruginosa was dominated, accounting for 24.32%.4. 74 strains of pathogenic bacteria were isolated from 30 cases of diabetic foots.. The bacterial detection rate was 93.33%. The mixed infection rate was 50%. Gram positive bacteria accounted for 39.19%. Gram negative bacteria accounted for 55.41%. Fungi accounted for 6.82%. Dominated by Pseudomonas aeruginosa and Staphylococcus aureus, were accounted for 18.18%.5. Compared with acute wounds and chronic wounds, the age, the mixed infection rate, the bacterial detection rate and the proportion of gram negative bacteria in chronic wounds was higher than that of acute wounds. The difference was statistically significant(P<0.05).6. In acute wounds and chronic wounds, the gram positive bacterias were highly resistant to penicillin and erythromycin. And no gram positive bacterias were found resistant to linezolid, vancomycin, and tigecycline. The gram positive bacterias in chronic wounds have higher resistant rate to oxacillin, sulfamethoxazole trimethoprim, ciprofloxacin than acute wounds(P<0.05).The strains in chronic wounds were found resistant to gentamicin, levofloxacin, rifampicin and sulfamethoxazole trimethoprim.7. Gram negative bacterias in acute wounds and chronic wounds had high resistance rate to ampicillin, cefazolin, cefuroxime, more than 70%. The gram negative bacterias in chronic wounds have higher resistant rate to Cefuroxime, ceftriaxone than acute wounds(P<0.05). Pseudomonas aeruginosa has a strong resistance rate. To ampicillin, ampicillin / sulbactam, cefazolin, cefuroxime, cefotetan, ceftriaxone, nitrofurantoin, the resistance rate was 100%. To imipenem, meropenem, Amikacin, ciprofloxacin, levofloxacin, the resistance rate was less than 6.25%.8. MRSA in overall skin and skin-soft tissue infections accounted for 34.48% of Staphylococcus aureus. MRSA in acute wounds accounted for 29.41%.And MRSA in chronic wounds accounted for 41.67%. Staphylococcus aureus was resistant to penicillin. Staphylococcus aureus had high resistance rate to erythromycin, clindamycin. It had low resistance to gentamicin, ciprofloxacin, levofloxacin, rifampicin, cotrimoxazole. And the drug resistance rate of MRSA was much higher than that of MSSA. MRSA and MSSA were sensitive to linezolid, vancomycin, tigecycline.9. In the bacterial culture positive group, he white blood cell count, the percentage of neutrophils and the level of fasting blood glucose were higher than that of bacteria culture negative group. The difference was statistically significant(P<0.05).10.In 117 cases of chronic wound, diabetic foot was 30 cases, 25 cases of vascular ulcer, 6 cases of pressure ulcers. Other causes of wound no healing were in following: foreign body, postoperative complications, systemic disease, skin and skin-soft tissue malignant tumor, improper treatment measures taken, that accounted for about 1/3. ConclusionSkin and skin-soft tissue infections was mainly concerned with gram positive bacteria, especially staphylococcus aureus. As empirical antibiotics, we preferred to suitable antibiotics to guide the clinical application of antibiotics. When the patient had a chronic wound and combined of basic diseases or elderly, it was to be aimed at Gram-negative bacteria, especially in Pseudomonas aeruginosa. We empirically preferred better antibiotics. There were many reasons for wound difficult healing. We should actively seek the cause of wound healing, and actively remove the cause and timely take treatment measures. For diabetic foots, we should strive for early detection, early prevention and early treatment. We should combine the control of blood sugar, improvement of blood circulation, nutrition, the anti-infection treatment and surgical intervention, to reduce the possibility of amputation and improve the quality of life.