烧伤患者细菌耐药性的监测

目的 监测烧伤患者中细菌的耐药性,方法 （１）用纸片法进行药物敏感试验,并以有关临床实验室标准数值作为判断耐药标准。（２）用舒巴坦２０μｇ加入于４种头孢菌素纸片内,对多重药的铜绿假单胞菌及肺炎克雷伯村菌进行药敏试验,检测超广谱β－内酰胺酶的产生,并与未加舒巴坦的药敏纸片进行对照。结果 从烧伤患者中分离到细菌菌株２２７株,其中革兰阴性杆菌有１９５株,占８６％,经药敏试验显示各种细菌均有较高耐药性,且

Monitoring of bacteria resistance in burn patients

OBJECTIVE: To monitor the bacteria resistance in burn patients. METHODS: Disk susceptibility tests were performed and interpreted according to the NCCLS criteria. Four kinds of the third generation cephalosporins extended-spectrum beta-lactamase produced by multi-resistant of P. aeruginosa and K. Pneumoniae strains were detected after 20 microgram of sulbactam was added respectively, in contrast to no sulbactam. RESULTS: 227 strains were isolated from burn patients. 195 strains (86%) were gram-negative bacteria. Disk susceptibility showed various bacteria had high antibiotic resistance and multi-resistant rate. S. aureus was only susceptible to vancomycin, its resistant rate to imipenem was 19%. P. aeruginosa was only susceptible to polymyxin-B, its resistant rate to ceftazidime was 20%. However, after stop using ceftazidime two years, the susceptibility to gram-negative bacteria recovered. The resistant rate of ceftazidime to P. aeruginosa, E. coli, K. pneumoniae were decreased respectively. The resistance to quinolones was increased. The resistant rate of ciprofloxacin to P. aeruginosa, K. pneumoniae was increased respectively. After 20 microgram sulbactam added to cephalosporins drug disks, the primary susceptibility of ceftazidime to P. aeruginosa and K. pneumoniae recovered, and the antibiotic was better than the other cephalosporins. CONCLUSIONS: It is important to monitor the bacteriology in burn patients at all time, and understand the changing pattern of bacterial flora, antibiotic susceptibility and bacterial strains spreading in burn ward. Extended-spectrum beta-lactamases is the cause of resistance. After sulbactam added to the third generation of cephalosporins, the beta-lactamases were inhibited, and the susceptibility of antibiotics to bacteria were increased and ceftazidime was prior to others.