大面积烧伤患者不同时段创面病原菌构成的变化规律

Changes in Bacteria Species in Severe Burn Wounds at Different Stages

目的分析大面积烧伤患者创面病原菌在不同时段内构成的改变规律，为在取得细菌学证据前采取有针对性的防治措施提供参考。方法分析2004—2006年收治的烧伤≥50．0％体表面积且在伤后5d内入院的患者，从烧伤创面分泌物中分离病原菌；采样点为伤后当天至伤后2个月。结果共分离到病原菌476株，G杆菌占64．1％；以金黄色葡萄球菌（SAU）、铜绿假单胞菌（PAE）和鲍氏不动杆菌（ABA）分别列第1～3位；在伤后第1和第6周至伤后2个月两个时段内均以G^＋菌为优势菌，且SAU为主要菌株；在伤后第2--5周，G菌为优势菌，PAE和ABA为创面感染的主要病原菌；在此阶段内，SAU的感染位居单个菌株的第1或第2位。结论在不同时段内烧伤创面的病原菌构成存在差异，在各时段内均应特别注意防治SAU的感染及ABA感染的上升趋势。

OBJECTIVE To analyze the changes in bacteria constitution in severe burn wounds in different stages so as to provide reference for clinical prevention and treatment. METHODS A total of 36 casualties with severe burn injuries （≥50.0% total burn surface area） and hospitalized within 5 days post-burns from 2004 to 2006 were enrolled in the study. Samples were collected in the burn wounds from the first day to two months post-burns. RESULTS Totally 476 bacterial strains were isolated and Gram-negative bacteria accounted for 64.1%. However, in term of the single bacterial strain, Staphylococcus aureus （SAU） ranked first and the follows were Pseudomonas aeruginosa （PAE） and Acinetobacter baumannii （ABA）. During the first week and the six weeks to 2 months post-burns, Gram-positive bacteria were dominant and SAU ranked first. From the second week to the fifth week, Gram-negative bacteria were dominant, PAE and ABA were the main bacteria. Even though Gramnegative bacteria dominated in these periods, SAU still ranked the first or the second in terms of single bacterial strain. CONCLUSIONS Bacteria constitution in burn wounds differs in different stages. It must be stressed to prevent infections of SAU regardless of any stages, as well as ABA infections since the percentage of ABA has increased markedly in recent years.