| 詹志芳,陈永翀.31例重度压疮合并脓毒症患者病原菌分布特点及治疗体会[J].中国烧伤创疡杂志,2020,(4):248~250. |
| DOI： |
| 中文关键词: 压疮 脓毒症 病原菌 分布特征 感染 创面 |
| 英文关键词:Pressure ulcers Sepsis Pathogenic bacteria Distribution characteristics Infection Wound |
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| 中文摘要: |
| 目的 分析重度压疮合并脓毒症患者的病原菌分布特点及治疗体会? 方法 收集 2015 年 1 月至 2019 年11 月丰台区南苑医院收治的31 例重度压疮合并脓毒症患者的病历资料, 所有患者均于入院后24 h 内进行创 面分泌物? 血液和 (或) 气管分泌物以及尿液病原菌培养与药物敏感试验, 并进行液体复苏? 抗感染等全身治疗及清创? 外涂湿润烧伤膏等局部治疗, 分析病原菌分布特点, 总结治疗体会? 结果 31 例患者病原菌培养均呈阳性, 且以革兰氏阴性菌感染率最高, 尤以大肠埃希菌最为多见; 革兰氏阳性菌次之, 主要为表皮葡萄球菌? 金黄色葡萄球菌及粪肠球菌; 真菌感染率最低, 均为白色念珠菌? 药物敏感试验结果显示, 对革兰氏阴性菌抗菌活性最强的药物为 亚胺培南, 对革兰氏阳性菌抗菌活性最强的药物为万古霉素, 对白色念珠菌抗菌活性最强的药物为氟康唑? 最终31例患者在28 d 内死亡14 例 (45.2%), 出院8 例 (25.8%), 病情平稳转入普通病房9 例 (29.0%)? 结论 重度压疮合并 脓毒症患者以革兰氏阴性菌感染为主, 可同时合并革兰氏阳性菌及真菌感染, 亚胺培南? 万古霉素及氟康唑为其敏感药物, 在患者病原菌培养和药物敏感试验结果出来之前, 经验性予以亚胺培南? 万古霉素等药物抗感染治疗至关重要。 |
| 英文摘要: |
| Objective To analyze the distribution characteristics of pathogenic bacteria and treatment experience in patients with severe pressure ulcers and sepsis. Methods The medical records of 31 patients with severe pressure ulcers and sepsis, admitted to the Intensive Care Unit (ICU) of Nanyuan Hospital of Fengtai District from January 2015 to Novem? ber 2019, were collected. Within 24 hours after admission, the culturing of wound secretions, blood and/or tracheal secretions, and urine pathogens and drug sensitivity tests were carried out on all patients. Then systemic treatments such as fluid resuscitation, anti?infection, and topical treatments such as debridement and external application of MEBO were performed. Distribution characteristics of pathogenic bacteria were analyzed and treatment experience was summarized. Results The results of pathogenic bacteria culturing were positive in all the 31 patients. Gram?negative bacteria presented the highest in? fection rate, especially Escherichia coli, followed by gram?positive bacteria mainly including Staphylococcus epidermidis, Staphylococcus aureus and Enterococcus faecalis; while fungus had the lowest infection rate and only Candida albicans was seen. The drug sensitivity test showed that Imipenem was the most powerful drug against gram-negative bacteria, Vancomycin was the most powerful drug against gram-positive bacteria, and Fluconazole was the most powerful drug against candida albicans. Among the 31 patients, 14 (45.2% ) died within 28 days, 8 (25.8% ) were discharged from hospital, and 9 (29.0% ) were in stable condition and transferred to the general ward. Conclusion In most cases, patients with severe pressure ulcers and sepsis are infected with gram-negative bacteria, probably accompanying with gram-positive bacteria and fungus, to which Imipenem, Vancomycin and Fluconazole are sensitive drugs in sequence. Before getting the results of pathogen culturing and drug susceptibility tests in such patients, empirical application of these anti-infective drugs, such as Imipenem and Vancomycin, is of great importance. |
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