烧伤病区革兰阳性球菌构成比的增加及头孢硫脒的抗感染作用

Increase in proportion of Gram-positive cocci isolates in burn unit and anti-infection effects of cephathiamidine

目的:通过近年来烧伤病区革兰阳性(G^+)球菌构成比的增加,说明抗 G^+球菌感染的重要性,探讨头孢硫脒(仙立素)在抗 G^+球菌感染的作用。方法:调查1995年至2001年三0四医院烧伤病区病原菌流行病学变化,观察 G^+球菌的变化趋势。汇总七家医院198例烧伤病人对头孢硫脒的临床验证结果,以头孢呋辛钠作为对照组,并进行了体外敏感试验,评估头孢硫脒对 G^+球菌的抗感染作用。结果:三0四医院烧伤病区共检测出病原菌2584株,1999年开始 G^+球菌构成比明显增加,高达51.48%,金黄色葡萄球菌占总检出菌的31.30%,MRSA 占金黄色葡萄球菌的73.74%,从而证明了 G^+球菌已成为烧伤病区病原微生物的优势菌群。临床观察的头孢硫脒组比头孢呋辛组疗效好,表现在:①病人体温转为正常的时间短(4.68d 对照组为5.17d);②临床感染症状控制或减轻总显效率高达88.46%(对照组为76.47%);③创面细菌清除率为77.24%(对照组为56.92%);④G^+球菌体外药敏试验显示头孢硫脒的敏感率达到89.89%,仅次于万古霉素(99.36%)。结论:近年来 G^+球菌已成为许多单位烧伤病区细菌构成比的优势菌群,头孢硫脒对 G^+球菌的抗感染作用仅次于万古霉素,可作为临床抗 G^+球菌感染的第一线首选药物。

Objective:The importance of combating Gram-positive cocci infections is mounting as a recent survey showing that detection rate of these organisms has been on the increase in a burn unit.This study was to evaluate the efficacy of cephathiamidine in controlling Gram positive cocci infection.Methods:The changes in epidemiology of bacterial infections in the burn unit of 304th Hospital during the period from 1995 to 2001 were investigated. The data of clinical trial of cephathiamidine in 198 patients with burns admitted to seven hospitals were collected. Another group of burned patients treated with cefuroxime sodium served as the controls.Meanwhile drug sensitiv- ity test was performed in vitro.The efficacy of cephathiamidine in the treatment of Gram-positive (G^+)cocci in- fection was also evaluated.Results:A total of 2584 strains of pathogens were isolated in the burn unit of 304th Hospital.Since 1999,the ratio of G^+ cocci among the isolates was markedly increased up to 51.48%.Staphylo- coccus aureus accounted for 31.30% of all isolated bacteria,and MRSA (methicillin-resistant Staphylococcus au- reus)accounted for 73.74% of all Staphylococcus aureus isolates.These findings demonstrated that G+ cocci be- came the dominant pathogenic bacteria in the burn unit.Clinical data showed that the therapeutic effect of cephath- iamidin was better than cefuroxime,as evidenced by a shorter febrile period (4.68days vs 5.17 days),higher rate of amelioration of infectious symptoms (88.46% vs 76.47%),higher rate of bacteria clearance from burn wounds (77.24% vs 56.92),and in vitro drug sensitivity as high as 89.89%,which was only slightly inferior second to vancomycin (99.36%),but higher than cefuroxime (71.28%).Conclusion:G^+ cocci have become the dominant bacteria recently in many burn units.The efficacy of cephathiamidine in controlling G^+ cocci infection was only slightly inferior to vacomycin.Therefore,cephathiamidine could probably be use as the drug of first choice for the treatment of G^+ cocci infections.