重度烧伤早后期创面细菌菌种变化及临床治疗的经验探讨

Change of predominant bacterial strains on burn wound from early to later stage and the experience of clinical treatment

摘要:

目的总结重度烧伤早后期创面细菌菌种变化及治疗的经验教训.方法对1997～2003年收治的37例重度以上烧伤,住院时间均超过60d患者,通过调查住院期间,进行创面细菌培养和药物敏感试验资料.结果共检出细菌58株,其中革兰阳性菌19株,革兰阴性菌39株,主要以阴沟肠杆菌,铜绿假单胞菌为主,其次为金黄色葡萄球菌和肠球菌.铜绿假单胞菌对哌拉西林、阿米卡星、头孢他啶的药物敏感率在60%～75%之间,对亚胺培南药物敏感率为100%,阴沟肠杆菌对头孢三代耐药明显,对阿米卡星、亚胺培南药物敏感率分别为58%、100%,而金黄色葡萄球菌对苯唑西林、红霉素、万古霉素药物敏感率分别为42.8%、57%、100%,肠球菌耐药率较高,大部分肠球菌仅对万古霉素或去甲万古霉素敏感.结论烧伤早期创面细菌以革兰阴性菌为主,烧伤后期创面细菌革兰阳性菌较多.这些细菌的耐药菌株明显增多.耐药菌株的感染是造成重度烧伤患者创面延迟愈合的主要原因.正确合理使用抗生素,及时正确处理创面是防治烧伤感染的有效方法.

Abstract:

Objective: To summarize the change of predominant bacterial strains on burn wound from early to later stage and the experience of clinical treatment. Methods: This bacterial investigationg was carried out in 37 cases of severely burned patients. All the patients were in hospital more than 60 days from 1997 to 2003, the bacterial culture and the drug susceptibility test were carried out. Results: 58 stains of bacteria were cultured, 39 stains of bacteria were the Gram-negative, 19 bacteria were the G+, the mainly bacteria were Sewer enteric bacilli and Pseudomonas aeruginosa, the secondly were S.aureus and Enterobacter. The sensitivity of Pseudomonas aeruginosa to Piperacillin, Amikacin and Ceftazidime was between 60% to 70%, to Imipenem was 100%. The Sewer enteric bacilli resistant to the third generation Cefamycillin was serious, the sensitivity of Sewer enteric bacilli to Amikacin and Imipenem was 58% and 100%, the sensitivity of S.aureus to Oxacillin, Erythromycin and Vancomycin was 42.8%, 57% and 100%. Most of Enterobacterl resistant to the mass of antibiotics, only be sensitive to Vancomycin and Norvacomycin. Conclusion: The results suggested the Gram-negative bacteria be predominant bacterial strains on burn early wound, the G+ bacteria be predominant bacterial strains on burn later wound. The resisitance of these bacteria to antibiotics is on the increase, These bacteria cause severely burned patients wound to postpone recovery. This implys rational and correct use of antibiotics and care wound correctly are effective methods to prevent and careburn infection.