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目的分析职业性三氯乙烯药疹样皮炎(OMDT)患者医院感染的临床特点和耐药性,指导临床合理治疗。方法收集1997年1月至2011年12月本院收治的186例OMDT患者的临床资料,对医院感染发生情况、病原菌分布与药敏试验结果进行回顾性分析。结果①186例患者中31例发生医院感染,感染率为16.7%(31/186)。②477份送检标本共检出病原菌131株,检出阳性率27.5%。革兰氏阳性(G+)球菌是主要致病菌(50.4%),革兰氏阴性(G-)杆菌、真菌各占27.5%、22.1%。金黄色葡萄球菌为优势菌(32.8%)。③离体药敏试验显示,G+球菌与G-杆菌对于青霉素类、头孢菌素类(第1、2代)、氨基糖苷类、大环内酯类、四环素类、喹诺酮类抗菌药物多数处于中介、高度耐药或者全耐药状态,出现对万古霉素、亚胺培南的耐药G+球菌菌株。G+球菌如金黄色葡萄球菌对万古霉素的敏感率均高于亚胺培南(P<0.001),G-杆菌对亚胺培南、头孢他啶、头孢噻肟、头孢三嗪敏感性较高。结论 OMDT患者容易并发医院感染,耐药率高,应制定抗菌药物临床应用管理规范,规范进行耐药性监测,指导临床合理用药。
Objective To analyze the clinical characteristics and drug resistance of hospitalized patients with occupational trichlorethylene dermatitis (OMDT) and to guide clinical rational treatment. Methods The clinical data of 186 patients with OMDT admitted from January 1997 to December 2011 in our hospital were collected. The incidence of nosocomial infections, the distribution of pathogens and drug susceptibility test results were retrospectively analyzed. Results Among the 186 patients, 31 cases developed nosocomial infection, the infection rate was 16.7% (31/186). ② There were 131 strains of pathogens detected in 477 samples, the positive rate was 27.5%. Gram-positive (G +) cocci were the main pathogen (50.4%), Gram-negative bacteria (G-), fungi each accounted for 27.5% and 22.1% respectively. Staphylococcus aureus is dominant bacteria (32.8%). ③ In vitro susceptibility test showed that G + cocci and G-bacteria for penicillins, cephalosporins (first and second generation), aminoglycosides, macrolides, tetracyclines, quinolone antibiotics are mostly intermediaries , Highly resistant or fully resistant to vancomycin, imipenem resistant strains of G + cocci. The sensitivity of G + cocci such as Staphylococcus aureus to vancomycin was higher than that of imipenem (P <0.001). The sensitivity of G-bacteria to imipenem, ceftazidime, cefotaxime and ceftriaxone was high. Conclusions Patients with OMDT are prone to nosocomial infection and have high drug resistance rate. Practice should be made for the management of clinical application of antimicrobial agents, to standardize the monitoring of drug resistance and to guide clinical rational drug use.