目的 探討2013—2016年?？谑械谝话似哚t(yī)院四肢創(chuàng)傷性骨折感染病原菌的分布和耐藥性情況，為臨床合理用藥提供依據(jù)。方法 對(duì)?？谑械谝话似哚t(yī)院2013年3月—2016年3月收治的四肢創(chuàng)傷性骨折住院患者3 841例進(jìn)行回顧性分析，收集病原菌感染的83例患者的資料，對(duì)其病原菌的分布及藥敏結(jié)果進(jìn)行回顧性分析。結(jié)果 共分離出病原菌89株，其中革蘭陰性菌28株，構(gòu)成比為31.46%，主要為大腸埃希菌、陰溝腸桿菌、肺炎克雷伯菌、銅綠假單胞菌和產(chǎn)氣腸桿菌；革蘭陽性菌61株，構(gòu)成比為68.54%，主要為金黃色葡萄球菌、表皮葡萄球菌、糞腸球菌和鳥腸球菌。大腸埃希菌對(duì)氨芐西林、左氧氟沙星、舒巴坦、超廣譜β內(nèi)酰胺酶、頭孢曲松、頭孢唑啉的耐藥率為70.00%~100.00%；而對(duì)厄他培南、哌拉西林、丁胺卡那霉素、紅霉素、亞胺硫霉素敏感。陰溝腸桿菌對(duì)亞胺硫霉素的耐藥率為0.00%，對(duì)其他抗菌藥物的耐藥率為25.00%~100.00%。革蘭陽性菌中金黃色葡萄球菌和表皮葡萄球菌均對(duì)氨芐西林、達(dá)福普丁、利奈唑胺、替加環(huán)素、呋喃妥因敏感，表皮葡萄球菌還對(duì)環(huán)丙沙星敏感，耐藥率為0.00%；兩者對(duì)青霉素均不具有耐藥性，耐藥率為100.00%。此外，兩者對(duì)其他的抗菌藥物耐性率均不達(dá)50.00%。結(jié)論 海口市第一八七醫(yī)院四肢創(chuàng)傷性骨折感染病原菌以革蘭陽性菌為主，臨床應(yīng)結(jié)合藥敏試驗(yàn)，合理選用抗菌藥物；同時(shí)要重視加強(qiáng)細(xì)菌耐藥性的檢測。

Objective To investigate the distribution and drug resistance of pathogenic bacteria of patients with traumatic limbs fracture in No.178 Hospital of Haikou from 2013 to 2016, and to provide reference for clinical rational drug use.Methods Inpatients (3 841 cases) with traumatic limbs fracture in No.178 Hospital of Haikou from March 2013 to March 2016 were analyzed retrospectively. The data of 83 cases of patients infected by pathogenic bacteria was selected, and the distribution and drug resistance of pathogenic bacteria were analyzed retrospectively.Results Totally 89 strains of pathogens were isolated, in which Gram-negative bacteria were 28 strains (31.46%), main of them were Escherichia coli, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Enterobacter aerogenes. Gram-positive bacteria (61 strains) accounted for 68.54%, and main of them were Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, and Enterococcus avium. The resistance rates of E. coli against ampicillin, levofloxacin, sulbactam, extended spectrum β lactamases, ceftriaxone, and cefazolin were 70.00% — 100.00%. E. coli was sensitive to ertapenem, piperacillin, amikacin, erythromycin, and imipenem. The resistance rate of E. cloacae against imipenem was 0.00%, and against other antibiotics were 25.00% — 100.00%. In Gram-positive bacteria, S. aureus and S. epidermidis were sensitive to ampicillin, dalfopristin, linezolid, tigecycline, and macrodantin. S. epidermidis was also sensitive to ciprofloxacin, and the resistance rate was 0.00%. The sensitive rates of S. aureus and S. epidermidis against penicillin were 100.00%. Besides, the sensitive rates of S. aureus and S. epidermidis against other antibiotics were less than 50.00%. Conclusion The main pathogens of patients with traumatic limbs fracture in No.178 Hospital of Haikou is Gram-positive bacteria. It is important to choose rational antibiotics according to the drug sensitive test and enhance the detection of drug resistance.