Clinical experience with prophylactic antibiotic bowel suppression in burn patients.
Clinical experience with prophylactic antibiotic bowel suppression in burn patients.
复制标题
烧伤患者预防性抗生素肠抑制的临床经验。
作者：
F. Jarrett;E. Balish;J. Moylan;S. Ellerbe
本文报告了20例烧伤病人在层流烧伤病房中应用新霉素-红霉素-制霉菌素口服预防性抗生素方案抑制肠道植物群的效果。该方案平均使用24天。每周两次从烧伤伤口的多个区域获得表面培养物，并且每周进行一到两次烧伤伤口活组织检查。前瞻性比较这些患者与一组10例患者，除省略抗生素抑制方案外，其他治疗方式相同。接受抗生素治疗的组在入院后平均19天出现烧伤伤口的细菌定植，而对照组在入院后4天出现细菌定植（p <0.01）。在未接受抗生素治疗的组中，观察到烧伤活检阳性（每克组织超过10（5）个细菌）的频率是以下几种类型感染并发症的两倍（p <0.16）：菌血症、烧伤伤口脓毒症、尿路感染、肺炎、蜂窝织炎（0.10 <p <0.20）。在接受预防性抗生素治疗的患者中没有遇到葡萄球菌或真菌过度生长，长期使用新霉素对血清肌酐水平也没有不良影响。
An oral prophylactic antibiotic regimen (neomycin-erythromycin-nystatin) aimed at suppression of the bowel flora was utilized in 20 patients with thermal injury treated in a laminar flow burn unit with strict sterile technique and reverse isolation. The regimen was utilized for an average of 24 days. Surface cultures were obtained twice weekly from multiple areas of the burn wound, and burn wound biopsies were performed one to two times weekly. These patients were compared prospectively with a group of 10 patients treated in otherwise identical fashion, save for the omission of the antibiotic suppressive regimen. Bacterial colonization of the burn wound occurred an average of 19 days after admission in the group receiving antibiotics compared to 4 days after admission in the control group (p less than 0.01). Positive burn biopsies (more than 10(5) bacteria per gm of tissue) were observed twice as often in the group not receiving antibiotics (p less than 0.16) as were infectious complications of several types: bacteremia, burn wound sepsis, urinary tract infections, pneumonitis, cellulitis (0.10 less than p less than 0.20). Staphylococcal or fungal overgrowth were not encountered in the patients receiving prophylactic antibiotics, nor was there an adverse effect on serum creatinine levels with the prolonged use of neomycin.