烧伤侵袭性感染的抗生素起始治疗对策

Initiation strategies of systemic administration of antibiotics in the treatment of invasive infection of burns

目的分析烧伤病房侵袭性感染患者连续创面细菌学培养及药敏监测结果,探讨在烧伤侵袭性感染起始治疗中抗生素经验性选择和应用方法。方法回顾分析1998-01～2004-06笔者所在医院烧伤科161例创面和焦痂下组织中分离出402株细菌监测资料,并对细菌菌种、分布特点、耐药状况进行了讨论。结果161例患者创面分离出细菌291株,焦痂下组织分离出细菌111株。创面和焦痂革兰阴性(G-)杆菌检出百分比显著高于革兰阳性(G+)球菌;铜绿假单胞菌和肠杆菌科细菌为G-杆菌的主要菌种,金黄色葡萄球菌(金葡菌)为G+球菌的主要菌种;G-杆菌对第三代头孢菌素和丁胺卡那霉素(amikacin)耐药率较高。结论对烧伤患者发生侵袭性感染时采用抗生素起始治疗的适当策略是亚胺硫霉素(Imipenem)和万古霉素联用,高度疑有G-杆菌感染时首选亚胺硫霉素,高度疑有G+球菌感染者应首选万古霉素。

Objective By analysing the results of drug-sensitive test monitoring and continoas wound bacteriological culture so as to probe into the methods of experimental selection and application of antibiotics for initiation treatment of invasion infection of burns. Methods The monitoring data of 402 strains separated from wound and subscab tissue of 161 cases with burn （from Jan, 1998 to June, 2004） were analysed retrospectively, then the relative bacteria species, disturbution characters and drug- resistant status were discussed. Results Among 402 strains 291 were separated from patients wound, 111 from subscab tissue. The detected rates of G^- bacteria from wound and subscab tissue were higher than that of G^＋ coccus, among which enteric bacillus and P. aeruginosa were main species of the G^-, while staphylococcus aureus was main species of G^＋ coccus; drug-resistance rate of G^- bacteria to third-generation cephalosporins and amikacin was higher. Conclusion Suitable strategies in initiation treatment of invasive infection of bums should be combination of imipenem and vancomycin; for highly suspected G^- bacteria infection imipenem should be first choice, while for G^＋ coccus should be vancomycin.