烧伤感染的细菌学特点及抗菌药物选择.doc

烧伤感染的细菌学特点及抗菌药物选择 烧伤感染的细菌学特点及抗菌药物选择 2010-04-23 苏东　张学英　秦志刚　邓诗琳　张艳红　王金良 　　【摘要】　目的　为了解引起烧伤感染的细菌学特点及为临床合理用药提供实验室依据。方法　利用VITEK-AMS进行鉴定和药敏试验。结果　共检出2005株细菌包括19个菌属中的63个菌种。铜绿假单胞菌分离率为各种细菌之首，分离率达36.86%，每年分离率有所下降。金黄色葡萄球菌位居第二，分离率为14.92%，且有上升的趋势。结论　烧伤感染中以铜绿假单胞菌、金黄色葡萄球菌、阴沟肠杆菌、醋酸钙不动杆菌、粪肠球菌、大肠埃希菌、奇异变形杆菌及肺炎克雷白菌8种细菌为主。对G-杆菌引起的烧伤严重全身性感染第三代头孢菌素及亚胺培南应作为首选药物。而第一、二代头孢菌素、青霉素类抗生素及复合制剂药物应在明确病原菌及药物敏感试验结果后指导性应用。万古霉素应作为治疗烧伤严重全身性耐甲氧西林金黄色葡萄球菌感染的首选药物。 　　【关键词】　烧伤　　感染　　细菌　　耐药 The bacteriological characters of burn infection and the use of antimicrobial agents SU Dong,ZHANG Xueying,QIN Zhigang,et al. Tianjin Fourth Hospital,Tianjin 300222 　　【Abstract】　Objective　In order to use antimicrobial agents reasonably in the treatment of burn infection,the bacteriological character of clinical isolates were evaluated.Methods　Two thousand and five clinical isolates from burn infections were identified and the susceptibility test of which were performed by VITEK-AMS concurrently.Results　Two thousand and five strains were identified to be of 63 species of 19 genuses.P.aeruginosa was the most common organism (36.86%).However, the isolates of P.aeruginosa were reducing year by year.The isolate rate of S.aureus isolates was 14.92% next to that of P.aeruginosa with a increasing trend.Conclusion　The predominant species of bacteria from burn infections were P.aeruginosa,S.aureus,E.cloacae,A.calcaceticus,E.faecalis,E.coli,P.mirabilis,and K.pneumoniae.In general infections of severe burn patients,the third generation cephalosporins and imipenem shoud be regarded as the first-line antibiotics against Gram negative bacilli while vancomycin should be the first choice to treat MRSA infection. 　　【Key words】　Burn　　Infection　　Bacterium　　Drug resistance 　　国外烧伤中心的资料表明烧伤面积超过30%的死亡病例中约70%死于感染，国内资料也相近似［1］。目前众多抗菌药物的广泛使用所导致的耐药菌株不断增加给临床治疗带来了十分困难的问题。现对我院1992～1997年引起烧伤感染的细菌分布及耐药性作了回顾性分析，为了解引起烧伤感染的细菌学特点及临床合理用药提供依据。 材料与方法 　　一、菌种来源 　　标本取自1992～1997年我院烧伤住院患者，从患者创面、静脉尖端、痂下组织及血液，分离培养菌株2 005株。 　　二、分离培养 　　烧伤患者创面分泌物用无菌棉拭子采集后接种于血平皿及麦