烧伤病区革兰氏阳性球菌构成比的增加及头孢硫脒的抗感染作用

目的 通过近年来烧伤病区革兰氏阳性球菌构成比的增加，说明抗革兰氏阳性球菌感染的重要性，探讨头孢硫脒在抗革兰氏阳性球菌感染的作用。方法 调查1995年至2001年304医院烧伤病区病原菌流行病学变化，观察革兰氏阳性球菌的变化趋势。汇总七家医院198例烧伤病人对头孢硫脒的临床验证结果，以头抱映辛作为对照组，并进行了体外敏感试验，评估头孢硫脒对革兰氏阳性球菌的抗感染作用。结果 解放军304医院烧伤病区共检测出病原菌2584株，1999年开始革兰氏阳性球菌构成比明显增加，高达51．48％，金黄色葡萄球菌占总检出菌的3l.30％，MRSA占金黄色葡萄球菌的73．74％，从而证明了革兰氏阳性球菌已成为烧伤病原微生物的优势菌群。临床观察的头孢硫脒组比头抱映辛组疗效好，表现为：①病人体温转为正常的时间短(4．68d，对照组为5．17d)；②临床感染症状控制或减轻总显效率高达88．46％(对照组为76．47％)；③创面细菌清除率为77．24％(对照组为56．92％)；④革兰氏阳性球菌体外药敏试验显示头孢硫脒的敏感率达到89．89％，仅次于万古霉素(99．36％)。结论 近年来革兰氏阳性球菌已成为许多单位烧伤病区细菌构成比的优势菌群，头孢硫脒对革兰氏阳性球菌的抗感染作用仅次于万古霉素，可作为临床抗革兰氏阳性球菌感染的首选药物。

Increasement of Gram positive cocci ratio in burn unit and effects of anti-infection of cefathiamidine

Objective The importance of combating Gram-positive cocci infections is mounting as a recent survey showing that detection rate of these organisms has been on the increasement in a burn unit. This study was to evaluate the efficacy of cefathiamidine in controlling Gram positive cocci infection. Methods The changes in epidemiology of bacterial infections in the burn unit of 304th Hospital of PLA during the period from 1995 to 2001 were investigated. The data of clinical trial of cefathiamidine in 198 patients with burn injured from seven hospitals were collected. Another group of burn patients who were treated with cefuroxime sodium were enrolled as the control group. Meanwhile drug sensitivity was carried out in vitro . The efficacy of cefathiamidine in the treatment of Gram positive cocci infection was evaluated. Results A total of 2584 strains were isolated in the burn unit of 304th Hospital of PLA. Since 1999, the ratio of Gram positive cocci among the isolates has been markedly increased up to 51.48%. Staphylococcus aureus accounted for 31.30%, and MRSA (methicillin-resistant Staphylococcus aureus ) accounted for 71.74% of all Staphylococcus aureus isolates.These demonstrated that Gram positive cocci have become the dominant pathogenic bacteria in the burn unit. Results showed that the therapeutic effect of cefathiamidine was better than cefuroxime, as evidenced by a shorter febrile period (4.68days vs 5.17 days), higher rate of amelioration of infections symptoms (88.46% vs 76.4%), higher rate of bacteria clearance rate from burn wounds(77.24% vs 56.92%), and in vitro drug sensitivity as high as 89.89%, which was only second to vancomycin (99.36%), but higher than cefuroxime (71.28%). Conclusion Gram positive cocci infection was only slightly inferior to vacomycin. Therefore, cefathiamidine could probably be used as the drug of first choice for the treatment of Gram positive cocci infections.