烧伤创面肠杆菌科细菌的耐药性及其意义

目的 探讨烧伤创面肠杆菌科细菌耐药性的变迁以指导临床抗生素的应用。方法 从263例烧伤病人创面分离获得试验菌株331株，按年份分三朗比较肠杆菌科细菌对多种抗生素耐药性的变化，并分析第三代头孢菌素中头孢他啶的耐药性与其临床应用频率的关系。结果 肠杆菌科细菌对第三代头孢菌素的耐药率由约50％降至近3年来的40％，头孢他啶的耐药率最低为28．9％，耐药率的变化趋势与药物应用频率和停用或启用有关。头孢哌酮—舒巴坦的耐药率一直在16％-19％；对阿米卡星耐药率从51.2％降至43．4％；对亚胺培南的耐药率则从14．3％降至6．8％。检出的肠杆菌科细菌中肺炎杆菌、臭鼻杆菌、肠杆菌属细菌、枸橼酸杆菌对不同类别抗生素的耐药率相对较高。结论 烧伤创面肠杆菌科细菌对第三代头孢菌素耐药率的变化可能与其临床应用频率有关。亚胺培南为目前针对多重耐药肠杆菌科细菌的首选抗生素。

Clinical Implication of Resistance to Antibiotics of Enterobacteriaceae solated from Burn Wounds and Subeschar Tissues

Objective To elucidate the clinical implication of the dynamic changes in resistance to antibiotics of enterobacteriaceae in burn wound to suggest the systemic application of suitable antibiotics in burn patients. Methods The distribution of enterobacteriaceae in the bacteriol spectrum of the burn wound and the subeschar tissues were retrospectively analyzed in 331 strains from the wounds of 263 burn patients, and in resistance to antibiotics was compared among cephalosporin, amikacin and imipenem. Results The resistance of identified strains of enterobacteriaceae to cephalosporin at a higher percentage of 50% decreased to 40% during the last 3 years and was lowest to ceftazidime (28.9%). The changes in resistance to cephalosporin might be associated with its frequent clinical applications. The resistance to sulbactam - cefoperazone was consistant at 16%-19% , to amikacin from 51.2% to 43.4% and to imipenem decreased from 14.3% to 6. 8% . Conclusion The resistance of enterobacteriaceae to cephalosporin may be related to frequent applications. To date for burn infection highly suspected with enterobacteriaceae. The first choice of antibiotics is imipenem.