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抗生素锁与肌注给药在治疗家兔中心静脉导管相关感染模型中的效果差异 被引量:1

Difference in efficacy between antibiotic lock technique and intramuscular injection for the treatment central venous catheter-related infection in rabbit model
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摘要 目的比较抗生素锁(ALT)与全身用药在治疗中心静脉导管相关感染中的效果差异。方法体外制作内含细菌生物膜的导管,并植入家兔中心静脉,将其随机分为两组:一组为导管组,向导管内注入抗生素与肝素混合液;一组为全身组,肌内注射抗生素,导管内注入肝素液。连续用药10 d,每日在更换药液前留取导管血和外周静脉血,检测菌落数。第11天停用全部抗生素,留置导管观察5 d再拔管。拔管前采导管血和外周血做细菌计数和药敏试验。并将拔出的导管做导管尖端细菌培养和生物膜观察。结果用药期间血培养细菌计数:不同用药时间导管组导管血细菌平均计数均低于全身组,差异具有统计学意义(均P<0.05);导管组外周血培养阳性标本从第4天开始逐渐出现,共有阳性标本6例;全身组阳性标本第2天即出现,共有阳性标本31例。停药期间血培养细菌计数:两组在拔管当日的导管血细菌计数均高于停药当日,差异均有统计学意义(均P<0.05)。停药当日导管组2例外周血标本检出细菌,全身组8例阳性;拔管当日导管组无新增阳性标本,而全身组有1例新增阳性标本。全身组的导管尖端细菌计数[(8.02±0.05)log10CFU/mL]高于导管组[(3.12±0.14)log10CFU/mL],差异有统计学意义(t=26.82,P<0.05)。导管组33.33%的标本可见散在生物膜,全身组全部标本被菌膜覆盖。拔管前导管血和外周血细菌培养及药敏试验:导管组的抑菌环直径在19~20 mm之间,全身组为15~16 mm,两组细菌对常见抗菌药物均为敏感。结论在治疗中心静脉导管相关感染中ALT局部清除细菌的效果优于全身用药,可降低全身感染。但是倘若导管内细菌生物膜未完全清除,停药后仍可复发,因此精准的用药量和用药时间值得进一步量化研究。 Objective To compare the efficacy of antibiotic lock technique (ALT) and systemic medication on the treatment of central venous catheter-related infection(CRI). Methods Catheters which had been formed bacterial biofilm in vitro were implanted into the central venous of rabbits, and rabbits were randomly divided into two groups, catheter group received the injection of mixture of antibiotics and heparin, systemic group received intra- muscular injection of antibiotics and intraductal injection of heparin solution. Medicine was given continuously for 10 days, catheter blood and peripheral venous blood were taken every day before replacing the medicine, bacterial colo- ny counts were detected. All rabbits stopped using antibiotics on day 11, then removed catheters after a 5-day ob- servation of catheterization. Before extubation, the catheter blood and peripheral blood were collected to perform bacterial colony counting and antimicrobial susceptibility testing, and removed catheters were performed catheter tip bacterial culture and observation of biofilm. Results During the medication period, the average bacterial counts of catheter blood in catheter group at different time were all lower than systemic group, difference was statistically sig- nificant(all P〈0. 05);from the 4th day, the catheter group gradually appeared positive specimens of peripheralblood culture(a total of 6 cases), and systemic group appeared positive specimens on the second day(a total of 31 ca- ses). During medicine withdrawal period, bacterial counts of catheter blood in two groups on the day of extubation were both higher than those on the day of medicine withdrawal, differences were both statistically significant(both P 〈0.05). On the day of medicine withdrawl, 2 cases in catheter group and 8 cases in systemic group were isolated bacteria from peripheral blood there was no new positive specimens in catheter group on the day of extubation, but there was 1 new positive specimen in systemic group. Catheter tip bacter
作者 敖薪 王娟 AO Xin WANG Juan(Yangtze University, J ingzhou 434023, China The First Affilia- ted Hospital of Xinjiang Medical University, Urumqi 830054, China)
出处 《中国感染控制杂志》 CAS 北大核心 2017年第10期920-924,共5页 Chinese Journal of Infection Control
基金 湖北省卫生和计划生育委员会基金项目(WJ2015HB036)
关键词 抗生素锁 中心静脉导管 导管相关感染 细菌计数 生物膜 antibiotic lock technique central venous catheter catheter-related infection bacteria count biofilm
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