急性细菌性皮肤感染病原菌耐药性及万古霉素治疗效果

Drug resistance of pathogens causing acute bacterial skin infection and therapeutic effect of vancomycin

目的探究急性细菌性皮肤感染病原菌耐药性及万古霉素治疗效果。方法选取2019年1月-2020年1月湖北文理学院附属医院收治的急性细菌性皮肤感染患者80例,治疗前采集患者皮损部位分泌物进行病原菌培养,并分析耐药性。随机数字表法分为对照组40例和研究组40例,对照组给予夫西地酸乳膏,研究组在对照组基础给予万古霉素。比较两组T淋巴细胞(CD_(3)^(+)、CD_(4)^(+)、CD_(8)^(+)、CD_(4)^(+)/CD_(8)^(+))、炎症因子[降钙原素(PCT)、高敏C-反应蛋白(hsCRP)、白细胞介素-6(IL-6)]、皮损[皮损面积及严重度指数(EASI)]及不良反应。结果80例急性细菌性皮肤感染患者的标本中分离出106株病原菌,革兰阳性菌和革兰阴性菌分别占比71.70%和28.30%;革兰阳性菌对青霉素、红霉素、克林霉素、四环素的耐药性较高,对利奈唑胺和万古霉素较敏感;革兰阴性菌对阿莫西林、氨苄西林、氨曲南、头孢曲松、头孢唑林、环丙沙星的耐药性较高,对亚胺培南较敏感;研究组CD_(3)^(+)、CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平高于对照组(P<0.05),CD_(8)^(+)、PCT、hsCRP、IL-6水平、EASI评分低于对照组(P<0.05);两组不良反应比较,无统计学差异。结论急性细菌性皮肤感染的病原菌种类丰富,且具有不同程度耐药性,采用万古霉素治疗可改善患者细胞免疫和炎性因子水平,缓解皮损,安全性好。

OBJECTIVE To explore the drug resistance of pathogens causing acute bacterial skin infection and observe the therapeutic effect of vancomycin.METHODS A total of 80 patients with acute bacterial skin infection who were treated in Affiliated Hospital of Hubei University of Arts and Sciences from Jan 2019 to Jan 2020 were enrolled in the study.The secretion specimens were collected from skin lesion sites for culture of pathogens,and the drug resistance of the pathogens was observed.The enrolled patients were randomly divided into the control group with 40 cases and the study group with 40 cases.The control group was treated with fusidic acid cream,and the study group was given additional vancomycin on basis of the treatment of the control group.The T lymphocytes(CD_(3)^(+),CD_(4)^(+),CD_(8)^(+),CD_(4)^(+)/CD_(8)^(+)),inflammatory factors[procalcitonin(PCT),high-sensitivity C-reactive protein(hsCRP),interleukin-6(IL-6)],skin lesions[lesion area and severity index(EASI)]and adverse reactions were compared between the two groups.RESULTS Totally 106 strains of pathogens were isolated from the specimens of the 80 patients with acute bacterial skin infection,71.70%of which were gram-positive bacteria,and 28.30%were gram-negative bacteria.The gram-positive bacteria were highly resistant to penicillin,erythromycin,clindamycin and tetracycline but were sensitive to linezolid and vancomycin.The gram-negative bacteria were highly resistant to amoxacillin,ampicillin,aztreonam,ceftriaxone,cefazolin and ciprofloxacin but were sensitive to imipenem.The levels of CD_(3)^(+),CD_(4)^(+) and CD_(4)^(+)/CD_(8)^(+) of the study group were significantly higher than those of the control group(P<0.05),the levels of CD_(8)^(+),PCT,hsCRP and IL-6 as well as EASI score were significantly lower in the study group than in the control group(P<0.05).There were no significant differences in the adverse reactions between the two groups.CONCLUSION There are a variety of species of pathogens causing the acute bacterial skin infection,and the pathogens vary in the drug resistance.Vancomycin can improve the cellular immunity and levels of inflammatory factors and relieve skin lesion,with the safety high.