烧伤创面感染病原菌分布及其耐药性研究

目的研究烧伤患者创面分泌物病原菌分布及其耐药性,为临床合理使用抗菌药物提供参考依据。方法采用细菌分离鉴定技术和药敏试验方法,对某医院280例患者烧伤创面分泌物病原菌进行检测与分析。结果280例患者烧伤创面分泌物中,检出病原菌者186例,检出率为66.43%。共培养出病原菌212株,革兰阴性菌占70.75%,革兰阳性菌占26.42%,真菌占2.83%。革兰阴性菌对常用抗菌药物均呈现不同程度耐药,仅对亚胺培南和美罗培南具有较高的敏感性;未检出革兰阳性菌对万古霉素、利奈唑胺和替考拉宁耐药菌株。结论该医院烧伤创面感染病原菌以革兰阴性杆菌为主,普遍产生耐药性,仅对碳青霉烯类抗菌药物敏感,提示应按照药敏试验结果选用抗菌药物,加强耐药监测,合理应用抗菌药物。     

269例下肢溃疡病原菌耐药性监测

目的观察269例下肢溃疡病原菌耐药性,为合理使用抗菌药物提供依据。方法通过细菌分离鉴定和药敏试验方法,对病人溃疡面标本进行了分离培养和药物敏感性测定。结果在269例下肢溃疡的患者创面上共分离出389株致病菌,其中革兰阳性菌占51.4%,革兰阴性菌占32.4%,厌氧菌占15.2%,真菌占1.0%。金黄色葡萄球菌对青霉素G、红霉素及氨苄西林/舒巴坦的耐药率分别为91.3%、70.4%和66.1%;革兰阳性菌仅对万古霉素全部敏感。革兰阴性菌仅对丁胺卡那霉素具有较高的敏感性。结论下肢溃疡患者创面感染以革兰阳性菌为主,所分离出的病原菌对临床常用抗菌药物普遍耐药。     

ICU肺炎患者的病原微生物分布及耐药性分析

目的：总结重症监护病房（ICU）肺部感染患者的病原微生物分布情况及耐药性分析,为临床抗生素的合理应用提供参考依据。方法：回顾性分析福建省福州市晋安区医院2019年6月-2021年6月ICU收治的肺部感染患者50例的临床资料,进行病原菌检测及耐药性分析。结果：50例患者中,共分离出病原菌75株,其中革兰阴性菌57株（76.0%）、革兰阳性菌12株（16.0%）、真菌6株（8.0%）,革兰阴性菌中铜绿假单胞菌占比最高,革兰阳性菌中金黄色葡萄球菌占比最高。耐药性分析显示革兰阴性菌对头孢曲松的耐药性高,革兰阳性菌中金黄色葡萄球菌对青霉素G的耐药性高。结论：ICU肺部感染的病原菌以革兰阴性菌居多,对多种抗生素药物存在耐药。临床医师应掌握肺部感染的病原体种类及其耐药情况,以便于合理指导抗生素的应用。     

1905株基层医院革兰阳性菌及革兰阴性菌耐药性分析

目的了解基层医院临床感染中革兰阳性菌及革兰阴性菌的病原菌分布及其耐药性,为指导临床合理用药提供理论依据。方法分析2007年1月至2010年1月住院和门诊病人送检的细菌培养标本,并做药物敏感性试验。结果分离出1 905株细菌中,革兰阳性菌634株（33.28%）、革兰阴性菌1 005株（52.76%）、真菌266株（13.96%）。葡萄球菌属细菌对青霉素耐药率最高（87.80%）,且凝固酶阴性的表皮葡萄球菌与凝固酶阳性的金黄色葡萄球菌的耐药性相似;常见革兰阴性非发酵菌对青霉素类抗菌药物大多耐药（85%）;肠杆菌科细菌对替卡西林耐药率最高（大于85%）。结论应加强对《抗菌药物临床应用指导原则》的学习和运用,合理使用抗菌药物,提高感染性疾病诊断和治疗水平。     

创伤感染病原菌分布及药敏分析

目的了解创伤分泌物标本主要病原菌及对目前抗生素的耐药性。方法对临床分离的247株病原菌及耐药性进行回顾性分析。结果革兰阳性菌84株．占34．0％；革兰阴性菌156株．占63.2％；真菌7株,占2．8％。细菌中排名前5位的分别是大肠埃希菌、金黄色葡萄球菌、假单胞菌、变形杆菌、表皮葡萄球菌。金黄色葡萄球菌与表皮葡萄球菌对青霉素、红霉素的耐药率为80%以上。革兰阴性菌对氨苄西林、复方新诺明、庆大霉素普遍耐药。结论临床应合理使用抗生素．遏制耐药菌的生长。     

重症监护病房医院感染病原菌的构成及耐药性

目的调查本院新启用重症监护病房（ICU）医院感染病原菌的构成及耐药特点,指导临床合理选用抗生索。方法用常规方法进行接种、分离、鉴定．用Kirby—bauer法进行体外药敏试验。结果共分离到147株细菌。其中革兰阴性菌85株（57．82％）、革兰阳性菌52株（35．37％）、真菌10株（6.8％）。革兰阴性菌主要为产超广谱β-内酰胺酶（ESBLs）的肺炎克雷伯菌和大肠埃希菌（41．89％）。对泰能敏感率100％;革兰阳性菌主要为金黄色葡萄球菌（88．46％）,其中甲氧西林耐药的金黄色葡萄球菌（MRSA）占金黄色葡萄球菌的91．30％,对万古霉素敏感率100％。结论本院ICU医院感染革兰阴性杆菌主要是产超广谱β-内酰胺酶（ESBLs）的肺炎克雷伯菌和大肠埃希菌;革兰阳性菌主要为甲氧西林耐药的金黄色葡萄球菌,细菌耐药性严重,应加强耐药性监测,合理使用抗生素。     

胆结石病患者胆汁细菌分布与耐药情况分析

目的了解胆结石病患者胆汁细菌分布与耐药情况,为临床医生使用抗生素提供依据。方法采用API鉴定系统进行病原菌鉴定,用琼脂纸片扩散法（K-B法）进行药敏试验。结果539例中共分离病原菌413株,阳性率76．6％;其中革兰阴性菌332株,占病原菌的80．4％,大肠埃希菌占首位,对氟哌酸、哌拉西林、复方新诺明耐药率较高,革兰阴性菌中产超广谱β内酰胺酶的菌株109株,占26．39％;革兰阳性菌81株,占病原菌的19．6％,肠球菌占首位,青霉素、氨苄西林耐药率较高。结论胆结石病患者胆汁细菌感染率较高,以肠道菌为主,耐药率较高,临床医生应按药敏结果选用抗生素。     

烧伤创面感染菌分布和耐药性分析

目的：了解烧伤创面感染菌的分布，细菌的耐药性，为治疗烧伤感染提供抗感染依据。方法：2001年1月～2003年12月本院住院烧伤患者进行细菌培养和耐药试验。统计致病菌的分布和耐药性。结果：烧伤创面标本中分离出致病菌149株，其中，革兰阴性菌73．2％，革兰阳性菌25．2％，真菌1．3％。耐甲氧西林金黄色葡萄球菌与耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为：79．6％，85．7％。结论：烧伤病房应加强细菌的检测和控制，保护患者创面免受感染。     

儿科住院病人下呼吸道感染的病原茵及耐药性分析

【目的】了解住院患儿下呼吸道感染的病原菌分布和细菌耐药情况,为临床合理用药提供参考。【方法】对本院儿科住院的1079例下呼吸道感染患儿的痰液标本经培养及药敏试验。【结果】共分离培养出病原菌446株,阳性率为41．3％,其中革兰阴性菌262株（58．7％）,革兰阳性菌169株（37．9％）,真菌5株（3．4％）;常见的病原菌为肺炎克雷伯菌、金黄色葡萄球菌、大肠埃希菌、肺炎链球菌、表皮葡萄球菌,年龄越小细菌的分离率越高（P〈o．05）。肺炎克雷伯及大肠埃希菌对目前临床上使用的大部分抗菌药物均有高、中度耐药性,而对氨基糖苷类、喹诺酮类、哌拉西林／他唑巴坦及第四代头孢菌素较敏感,亚胺培南敏感性迭100％,肺炎链球菌及两种葡萄球菌对青霉素及大环内酯类普遍耐药,对利福平、氨苄西林／舒巴坦、头孢唑林耐药率不高,未发现万古霉素耐药。【结论】住院病人下呼吸道感染以革兰阴性菌为主。不同年龄的感染率存在明显差异,抗生素耐药率较高,治疗上应根据病原菌培养的结果合理使用抗生素。     

皮肤软组织感染病原菌分布及耐药分析

摘要 目的 了解住院患者皮肤软组织感染病原菌分布及耐药情况,以指导临床科学选用抗菌药物。方法 通过性回顾性调查方法,对某医院住院皮肤软组织感染患者送检标本细菌培养及药敏试验结果进行统计分析。结果 从100例患者急性皮肤软组织感染创面中分离出病原菌68株,革兰阳性菌和革兰阴性菌分别占66.18%和33.82%。从100例患者慢性皮肤软组织感染创面分泌物细菌培养阳性87例,分离病原菌105株,革兰阳性菌和革兰阴性菌分别占31.44%和62.85%,真菌占5.71%。皮肤软组织感染标本分离的革兰阳性菌对青霉素和苯唑西林的耐药率高,革兰阴性菌对氨苄西林和复方新诺明等耐药率高。结论 急性和慢性皮肤软组织感染病原菌种类分布有所不同,耐药性也不尽相同,抗菌药物的选用应参考药敏试验结果。     

烧伤病区创面感染与医务人员手污染的相关分析

目的了解烧伤病区创面感染病原菌与工作人员手带菌情况,分析病原菌特征,并提出控制对策。方法调查深圳宝安区人民医院烧伤病区2006年-2007年住院烧伤患者,对烧伤创面感染者创面分泌物培养结果和工作人员手带菌情况进行调查分析。结果2006—2007年住院烧伤患者544例,发生烧伤创面感染48例,发病率8．82％。送检创面分泌物标本82份,检出病原菌株52株,其中G^-菌29株（55．77％）,G^＋菌22株（30．77％）,真菌1株（1．92％）。创面培养病原菌以金黄色葡萄球菌和铜绿假单胞菌为主;医务人员未经消毒手表面随机采样187份,检出细菌136株,细菌检出率71．96％,可见手污染带菌比例较高,其中以表皮葡萄球菌、铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌为主。结论创面感染病原菌与医务人员手污染菌有相关性,说明经医务人员污染手接触传播致烧伤创面感染情况不容忽视,故加强和重视烧伤病区医务人员手卫生监管对降低创面感染的发生有重要意义。     

Distribution and drug resistance of pathogens in burn patients in China from 2006 to 2019

BACKGROUNDIn this study, recent trends in the distribution and drug resistance of pathogenic bacteria isolated from patients treated at a burn ward between 2006 and 2019 were investigated.AIMTo develop more effective clinical strategies and techniques for the prevention and treatment of bacterial infections in burn patients.METHODSClinical samples with positive bacteria were collected from patients at the burn ward in Beijing Jishuitan Hospital in China between January 2006 and December 2019. The samples were retrospectively analyzed, the distribution of pathogenic bacteria was determined, and the trends and changes in bacterial drug resistance during different period were assessed. Drug resistance in several main pathogenic bacteria from 2006 to 2011 and from 2012 to 2019 was comparatively summarized and analyzed.RESULTSSamples from 17119 patients were collected and analyzed from 2006 to 2019. Surprisingly, a total of 7960 strains of different pathogenic bacteria were isolated at this hospital. Among these bacteria, 87.98% (7003/7960) of the strains were isolated from burn wounds, and only 1.34% (107/7960) were isolated from the blood of patients. In addition, 49.70% (3956/7960) were identified as Gram-positive bacteria, 48.13% (3831/7960) were Gram-negative bacteria, and the remaining 2.17% (173/7960) were classified as fungi or other pathogens. Importantly, Staphylococcus aureus (21.68%), Pseudomonas aeruginosa (14.23%), and Staphylococcus epidermidis (9.61%) were the top three pathogens most frequently isolated from patients.CONCLUSIONIn patients treated at the burn ward in this hospital from 2006 to 2019, Staphylococcus aureus and Pseudomonas aeruginosa were the predominant clinical pathogens responsible for bacterial infections. The circumstantial detection and detailed monitoring of the intensity and growth of different pathogenic bacteria in clinical patients as well as tests of drug sensitivity during burn recovery are particularly important to provide guidelines for the application of antibiotics and other related drugs. Careful collection and correct, standard culture of bacterial specimens are also crucial to improve the efficiency of bacterial infection detection. Effective monitoring and timely clinical treatment in patients may help reduce the possibility and rate of infection as well as alleviate the effects of drug resistance among patients in burn centers.     

The use of intestinal antibiotics to delay or prevent infections in patients with burns

Bacterial colonization and infection of wounds in seriously burned patients often comes from the patient's indigenous bowel flora. A prospective randomized clinical trial that involved 30 patients with 20% or greater total body surface area burns was undertaken to evaluate the use of a standard antibiotic bowel preparation in the delay or prevention of bacterial colonization of the burn wound and sepsis. Certain enteric bacteria were seen less frequently in the treated group (Enterobacter organisms), but other bacteria appeared more often in the treated group (Proteus organisms and enterococci). The average time of colonization of the burn wounds was 6.1 days in the treated group and 6.7 days in the control group. Blood cultures were positive for enteric organisms earlier in the treatment group. Pseudomonads appeared earlier in the wound and blood cultures of the treated group than in the control group. The effect of antibiotic bowel suppression in patients with burns is varied and unpredictable. The bowel preparation may select certain organisms and lead to earlier colonization of the wounds. Overall outcome and survival was not improved by the use of an antibiotic bowel preparation in these patients.     

FE复合溶菌酶治疗烧伤后期感染残余创面的临床研究

目的确证FE复合溶菌酶对烧伤后期残余创面杀菌作用与促愈作用。方法选取笔者单位烧伤残余创面患者30例,随机分为治疗组,用无菌纱布浸湿FE复合溶菌酶后湿敷创面。对照组用庆大霉素盐水纱布湿敷创面,2次／d。于用药前后取创面分泌物培养,观察FE复合溶菌酶对创面细菌敏感率并观察愈合时间及肝肾功情况。结果FE复合溶菌酶应用3d后,能杀死残余创面中89．9％的细菌,治疗组愈合时间明显短于对照组。差异有统计学意义（P〈0．01）使用后未见全身不良反应。结论FE复合溶菌酶治疗烧伤后期残余创面安全有效,可以有效控制残余创面感染,提高创面愈合率。     

Microbiological studies of four patients extensively burned by the pyroclastic flow of Mt. Fugen in Unzen,Japan

Serial microbiological tests were performed on 4 patients burned by the pyroclastic flow of Mt. Fugen in Unzen, Japan on June 3, 1991. The patients were young (average age, 30 years) and had extensive burns (average total burn surface area, 83%) and inhalation injury. All 4 patients died of multiple organ failure and septicemia. Methicillin-resistantStaphylococcus aureus (MRSA) andPseudomonas aeruginosa were persistently isolated from bronchial aspirates, burn wounds and the blood until death. There were no differences in isolates among the 3 specimen sites.S. aureus isolated from all patients became resistant to all antibiotics used, and the use of imipenem/cilastatin sodium, and ceftazidime transformedP. aeruginosa to a resistant strain within a short period of time. On the other hand, the sensitivity to gentamicin varied from one patient to another. From a study of the phenotypic character ofS. aureus strains, there was a suggestion of nosocomial infection in 2 patients. Our results demonstrate that extensive burns are usually associated with bacteremia and septicemia. In spite of prudent management with antibiotics, the control of resistant bacteria is difficult. We stress the need for the development of specific therapy for severe infections in burn patients, encompassing immunotherapy, antibiotic treatment, and wound treatment.     

A comparative study of two commercial systems for the enzymatic identification of enterobacteriaceae]

Two commercial test systems: Entero-Test manufactured in Czechoslovakia and made in the USSR are compared. Species identification of 33 newly isolated strains of gram-negative bacteria isolated from the wounds of subjects injured in the earthquake in Armenia was carried out. The advantages and shortcomings of the examined systems are analyzed. Species identification of Enterobacteriaceae by the two systems coincided in 97.2% of the examined cultures.     

烧伤患者医院感染情况调查及健康教育

目的　了解烧伤患者医院感染情况及相关因素。方法　对 680例烧伤患者进行回顾性调查分析。结果　 680例患者中 ,医院感染率为 7.94% ,医院感染与年龄、文化程度、经济状况、烧伤严重程度及患者的遵医行为有关 ;创面、肠道、呼吸道为病原菌侵入的主要途径 ,共占 79.63 % ;革兰阴性杆菌仍为感染病原菌的首位 ,占 75 .80 % ;实施健康教育前后的医院感染率比较 ,差异有极显著性 (P <0 .0 1)。结论　积极开展针对性健康教育是预防和控制烧伤患者医院感染的有效举措     

甘油保存异体皮在特重化学烧伤创面的应用

目的：探讨甘油保存异体皮在特大面积深度化学烧伤治疗中的应用。方法：回顾分析8例特大面积三乙基铝所致的深度烧伤，应用甘油保存异体皮覆盖创面的临床资料。其中7例患者在同一天内收治，8例均为男性．年龄19～46岁,平均年龄为29．25岁，创面面积80％～97％，平均为90％，其中Ⅲ度面积在50％～95％，平均为55．63％。其中7例伴吸入性损伤，行气管切开术，6例行呼吸机辅助通气。患者均在急诊室行补液、输血等支持治疗，彻底清创，行焦痂切开减压术，创面予SD—Ag外敷，并均在3～7d内分别分次行切痂术并采用甘油保存异体皮(GPA)覆盖创面，然后有计划地分别分次行自体皮片移植取代甘油保存异体皮，采用邮票植皮法和异体皮打洞自体皮嵌入移植法。切痂次数为2～3次，平均2．5次，植皮数为2～10次，平均7．2次。供皮区均为头皮，取皮次数为2～10次，平均7．2次。结果：2例因呼吸系统严重灼伤而分别于伤后13d和28d死于呼吸系统并发症，其Ⅲ度创面分别为30％和60％，死时的创面覆盖率分别为100％和80％。其余6例2个月后创面基本为自体皮片所覆盖，皮片愈合良好，皮片存活率约70％～90％，平均80％。头皮愈合良好。结论：甘油保存异体皮是大面积深度化学烧伤创面一种较好的临时覆盖物，它可以改善创面血供条件，为自体皮片移植做准备，提高自体皮片移植的存活率，为大面积深度化学烧伤的治疗赢得了时间，提高了救治成功率。     

Protegrin-1 enhances bacterial killing in thermally injured skin.

OBJECTIVE: Septic complications and the emergence of drug-resistant microbes represent serious risks to patients. Recently, naturally occurring peptides have been discovered that possess potent and broad-spectrum antimicrobial activity. Protegrin-1 is particularly attractive for clinical use in human wounds because, unlike defensins, protegrin-1 retains broad antimicrobial and antifungal activity at physiologic salt concentration and in the presence of serum. The objective of this study was to examine the efficacy of protegrin-1 in killing multiple drug-resistant microbes isolated from human burn patients. DESIGN: For thein vitroexperiment, bilayer radial diffusion was performed comparing standard antibiotics with protegrin-1 on multiple-drug-resistant microbial organisms isolated from infected burn wounds. In vivo, rats received a 20% total body surface area partial-thickness burn by immersion in 60 degrees C water for 20 secs followed by wound seeding with 106 colony forming units of Silvadene-resistant Pseudomonas aeruginosa. SETTING: University of Michigan research laboratory. SUBJECTS: Adult, male Sprague-Dawley rats. INTERVENTIONS: Rats were randomized into three groups: those receiving synthetic protegrin-1, acetic acid (carrier), or gentamicin (positive control). Protegrin-1 was administered by topical application or intradermal injection. Wound tissues were harvested aseptically at different time points for quantitative bacterial counts. MEASUREMENTS AND MAIN RESULTS: In vivo and in vitro experiments revealed rapid and significant decreases in bacterial counts for protegrin-1-treated groups compared with controls. CONCLUSIONS: This study shows that protegrin-1 potentially may be used as an alternative or adjunct therapy to standard agents used to treat wound infections.     

烧伤病人创面瘙痒发生现状及与负性情绪的相关性分析

目的:调查烧伤病人创面瘙痒发生现状,探究创面瘙痒症与负性情绪的相关性,为后期采用针对性心理疏导提供参考依据。方法:随机选取医院2018年6月—2021年1月烧伤科264例烧伤病人,收集研究对象基本信息,包括年龄、性别、吸烟史、饮酒史、致伤原因、是否植皮、全身烧伤面积。采用视觉模拟评分(VAS)评价病人烧伤创面瘙痒程度,使用焦虑自评量表(SAS)和抑郁自评量表(SDS)对烧伤病人负性情绪进行评估。采用Spearman相关性分析探讨烧伤病人创面瘙痒状况与负性情绪的相关性。结果:264例烧伤病人创面瘙痒发生率为70.83%,创面瘙痒组病人的SAS、SDS评分均明显高于创面无瘙痒组(均P<0.001);不同烧伤创面瘙痒程度的病人SAS、SDS评分比较差异有统计学意义(均P<0.001),即创面瘙痒越严重,烧伤病人负性情绪越严重。Spearman相关性分析同样显示创面瘙痒程度与焦虑、抑郁呈明显正相关(r值为0.580、0.462,均P<0.001)。结论:烧伤病人瘙痒发生率较高,病人出现创面瘙痒往往伴随负性情绪,临床中应重视此类人群的心理护理,采取针对性措施用于缓解病人的负性情...