摘要
目的:调查严重烧伤患者早期采用降阶梯治疗后创面细菌学及其药敏情况的变化,为抗生素合理应用提供理论依据。方法:对2000年～2003年我科收治的48例大面积危重烧伤病人采用降阶梯治疗方案,并在抗生素治疗前、治疗后第三天、第七天采集创面分泌物行动态细菌学和药物敏感调查。结果:送检144份样本共检出细菌94份(65.3%), 治疗前48份创面分泌物送检细菌学培养加药物敏感性测定,其中46份为阳性(95.8%),以表皮葡萄球菌、金葡菌、大肠杆菌、绿脓杆菌多见,对大多数抗生素敏感。第三天48份标本有17份阳性(35.4%),以阴沟肠杆菌、变形杆菌、假单孢菌类多见,对部分抗生素耐药。第七天48份标本31份阳性(64.5%),以不动杆菌、假单孢菌、肠杆菌、真菌多见,对大多数抗生素耐药。大面积烧伤患者早期采用降阶梯治疗后,创面菌群发生显著变化,在一周左右耐药菌株的检出率显著增高,结论:严重烧伤降阶梯治疗一周左右,应该及时停用或更换抗生素。
Objective： To observe the effect of antibiotic de-escalation therapy on the morphology of flora in bum wounds and drug sensitivity of the bacteria at the early stage of severe bum, in order to provide theoretical basis for rational use of antibiotics. Method： 48 cases of extensive bum were treated with de- escalation therapy. Wound excreta samples were examined before de - escalation therapy and 3, and 7 days after the therapy, to make clear any changes in the morphology and drug sensitivity of the bacteria. Result： 94 out of the 144 sampies （65.3%） gave positive bacteria cultivation results. Before de- escalation therapy, 46 out of the 48 wound excreta samples （95.8%） gave positive result and most of the bacteria were sensitive to antibiotics. On day 3 post therapy, 17 out of the 48 samples （35.4%） gave positive result but parts of the bacteria became drug resistant. On day 7 post therapy, 31 out of the 48 samples （64.5%） gave positive result and most of the bacteria became drug resistant. Conclusion： In applying de - escalation therapy, after 7 days, the administration of antibiotic should be withdrawn or should be replaced by other antibiotic drug.
出处
《中国烧伤创疡杂志》
2005年第4期272-276,共5页
The Chinese Journal of Burns Wounds & Surface Ulcers
关键词
降阶梯治疗
烧伤创面
细菌
De- escalation therapy
bum wound
bacteria
