【摘要】 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，对多重耐药的铜绿假单胞菌及肺炎克雷伯杆菌进行药敏试验，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，且多重耐药性的发生率较高。如金黄色葡萄球菌仅对万古霉素敏感，对泰能的耐药率已高达１９％。铜绿假单胞菌仅对多粘菌素Ｂ敏感，对头孢他啶的耐药率仍有２０％。但在停用一段时间后耐药率可以逆转，如铜绿假单胞菌、埃希氏大肠杆菌、肺炎克雷伯杆菌对头孢他啶的耐药率下降。对喹诺酮类药物的耐药率有明显增加，如铜绿假单胞菌、肺炎克雷伯杆菌对环丙沙星耐药率上升。在药敏纸片中加入２０μｇ舒巴坦后，原先对头孢他啶耐药的铜绿假单胞菌均能恢复敏感，同时我们发现舒巴坦对头孢他啶的作用优于其它头孢菌素，加入后其抑菌圈直径可增加５～１４ｍｍ。结论对烧伤患者定期进行细菌学监测，对了解菌群变化、药敏、病区内流行菌株的变迁及指导临床医生应用抗生素殊为重要。β内酰?更多还原

【Abstract】 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 extendedspectrum lactamase produced by multiresistant of P.aeruginosa and5BX K.Pneumoniae strains were detected after 20 g of sulbactam was added respectively, in contrast to no sulbactam. Results 227 strains were isolated from burn patients. 195 strains (86%) were gramnegative bacteria. Disk susceptibility showed various bacteria had high antibiotic resistance and multiresistant rate. S.aureus5BZ was only susceptible to vancomycin, its resistant rate to imipenem was 19%. P.aeruginosa was only susceptible to polymyxinB, its resistant rate to ceftazidime was 20%.However, after stop using ceftaxidime two years, the susceptibility to gramnegative bacteria recovered. The resistant rate of ceftazidime to P.aeruginosa, E.coli, K.pneumoniaeZ were decreased respectively. The resistance to quinolones was increased. The resitant rate of ciprofloxacin to P.aeruginosa,K.pneumoniaeBZ was increased respectively. After 20 g 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.Extendedspectrum lactamases is the cause of resistance.After sulbactam added to the third generation of cephalosporins, the lactamases were inhibited, and the susceptibility of antibiotics to bacteria were increased and ceftazidime was prior to others.更多还原