抗生素鎖與肌注給藥在治療家兔中心靜脈導(dǎo)管相關(guān)感染模型中的效果差異
發(fā)布時間：2019-01-27 19:01
【摘要】：目的比較抗生素鎖(ALT)與全身用藥在治療中心靜脈導(dǎo)管相關(guān)感染中的效果差異。方法體外制作內(nèi)含細菌生物膜的導(dǎo)管,并植入家兔中心靜脈,將其隨機分為兩組:一組為導(dǎo)管組,向?qū)Ч軆?nèi)注入抗生素與肝素混合液;一組為全身組,肌內(nèi)注射抗生素,導(dǎo)管內(nèi)注入肝素液。連續(xù)用藥10 d,每日在更換藥液前留取導(dǎo)管血和外周靜脈血,檢測菌落數(shù)。第11天停用全部抗生素,留置導(dǎo)管觀察5 d再拔管。拔管前采導(dǎo)管血和外周血做細菌計數(shù)和藥敏試驗。并將拔出的導(dǎo)管做導(dǎo)管尖端細菌培養(yǎng)和生物膜觀察。結(jié)果用藥期間血培養(yǎng)細菌計數(shù):不同用藥時間導(dǎo)管組導(dǎo)管血細菌平均計數(shù)均低于全身組,差異具有統(tǒng)計學意義(均P0.05);導(dǎo)管組外周血培養(yǎng)陽性標本從第4天開始逐漸出現(xiàn),共有陽性標本6例;全身組陽性標本第2天即出現(xiàn),共有陽性標本31例。停藥期間血培養(yǎng)細菌計數(shù):兩組在拔管當日的導(dǎo)管血細菌計數(shù)均高于停藥當日,差異均有統(tǒng)計學意義(均P0.05)。停藥當日導(dǎo)管組2例外周血標本檢出細菌,全身組8例陽性;拔管當日導(dǎo)管組無新增陽性標本,而全身組有1例新增陽性標本。全身組的導(dǎo)管尖端細菌計數(shù)[(8.02±0.05)log10CFU/mL]高于導(dǎo)管組[(3.12±0.14)log10CFU/mL],差異有統(tǒng)計學意義(t=26.82,P0.05)。導(dǎo)管組33.33%的標本可見散在生物膜,全身組全部標本被菌膜覆蓋。拔管前導(dǎo)管血和外周血細菌培養(yǎng)及藥敏試驗:導(dǎo)管組的抑菌環(huán)直徑在19~20 mm之間,全身組為15~16 mm,兩組細菌對常見抗菌藥物均為敏感。結(jié)論在治療中心靜脈導(dǎo)管相關(guān)感染中ALT局部清除細菌的效果優(yōu)于全身用藥,可降低全身感染。但是倘若導(dǎo)管內(nèi)細菌生物膜未完全清除,停藥后仍可復(fù)發(fā),因此精準的用藥量和用藥時間值得進一步量化研究。
[Abstract]:Objective to compare the efficacy of antibiotic locking (ALT) and systemic medication in the treatment of central venous catheter-related infection. Methods A catheter containing bacterial biofilm was made in vitro and implanted into the central vein of rabbits. The catheter group was randomly divided into two groups: one group was treated with a mixture of antibiotics and heparin into the catheter; In one group, systemic antibiotics were injected intramuscularly and heparin solution was injected into the catheter. For 10 days, catheter blood and peripheral venous blood were collected daily before changing the solution, and colony count was detected. All antibiotics were stopped on the 11th day and the catheter was placed for 5 days before extubation. Blood and peripheral blood were collected before extubation for bacterial count and drug sensitivity test. The drawn catheter was used for bacterial culture and biofilm observation at the tip of the catheter. Results the bacterial count of blood culture during the period of medication: the average count of blood bacteria in catheter group was lower than that in whole body group (P0.05). The positive specimens of peripheral blood culture in the catheterization group appeared gradually from the 4th day, there were 6 positive specimens, and 31 positive specimens appeared on the second day in the whole body group. The bacterial count of blood culture in the two groups on the day of extubation was higher than that on the day of withdrawal of the drug, and the difference was statistically significant (P0.05). Bacteria were detected in 2 peripheral blood samples in the catheter group and 8 in the whole body group on the day of withdrawal, but no new positive specimens were found in the catheter group on the extubation day, but one new positive specimen was found in the whole body group. The bacterial counts at the tip of the catheter in the whole body group [(8.02 鹵0. 05) log10CFU/mL] were significantly higher than those in the catheter group [(3. 12 鹵0. 14) log10CFU/mL] (t = 26. 82). 33. 33% of the specimens in the catheter group were scattered in the biofilm, and all the specimens in the systemic group were covered with bacterial membrane. Bacterial culture and antimicrobial susceptibility test in blood and peripheral blood before extubation: the diameter of bacteriostasis ring in the catheter group was between 19 and 20 mm, and that in the whole body group was 1516 mm,. Both groups were sensitive to common antimicrobial agents. Conclusion in the treatment of central venous catheter-related infection, the effect of ALT local removal of bacteria is better than that of systemic administration, and can reduce systemic infection. However, if the bacterial biofilm in the catheter is not completely removed, it can still recur after withdrawal.
【作者單位】： 長江大學;新疆醫(yī)科大學第一附屬醫(yī)院;
【基金】：湖北省衛(wèi)生和計劃生育委員會基金項目(WJ2015HB036)
【分類號】：R-332;R63
本文編號：2416589
[Abstract]:Objective to compare the efficacy of antibiotic locking (ALT) and systemic medication in the treatment of central venous catheter-related infection. Methods A catheter containing bacterial biofilm was made in vitro and implanted into the central vein of rabbits. The catheter group was randomly divided into two groups: one group was treated with a mixture of antibiotics and heparin into the catheter; In one group, systemic antibiotics were injected intramuscularly and heparin solution was injected into the catheter. For 10 days, catheter blood and peripheral venous blood were collected daily before changing the solution, and colony count was detected. All antibiotics were stopped on the 11th day and the catheter was placed for 5 days before extubation. Blood and peripheral blood were collected before extubation for bacterial count and drug sensitivity test. The drawn catheter was used for bacterial culture and biofilm observation at the tip of the catheter. Results the bacterial count of blood culture during the period of medication: the average count of blood bacteria in catheter group was lower than that in whole body group (P0.05). The positive specimens of peripheral blood culture in the catheterization group appeared gradually from the 4th day, there were 6 positive specimens, and 31 positive specimens appeared on the second day in the whole body group. The bacterial count of blood culture in the two groups on the day of extubation was higher than that on the day of withdrawal of the drug, and the difference was statistically significant (P0.05). Bacteria were detected in 2 peripheral blood samples in the catheter group and 8 in the whole body group on the day of withdrawal, but no new positive specimens were found in the catheter group on the extubation day, but one new positive specimen was found in the whole body group. The bacterial counts at the tip of the catheter in the whole body group [(8.02 鹵0. 05) log10CFU/mL] were significantly higher than those in the catheter group [(3. 12 鹵0. 14) log10CFU/mL] (t = 26. 82). 33. 33% of the specimens in the catheter group were scattered in the biofilm, and all the specimens in the systemic group were covered with bacterial membrane. Bacterial culture and antimicrobial susceptibility test in blood and peripheral blood before extubation: the diameter of bacteriostasis ring in the catheter group was between 19 and 20 mm, and that in the whole body group was 1516 mm,. Both groups were sensitive to common antimicrobial agents. Conclusion in the treatment of central venous catheter-related infection, the effect of ALT local removal of bacteria is better than that of systemic administration, and can reduce systemic infection. However, if the bacterial biofilm in the catheter is not completely removed, it can still recur after withdrawal.
【作者單位】： 長江大學;新疆醫(yī)科大學第一附屬醫(yī)院;
【基金】：湖北省衛(wèi)生和計劃生育委員會基金項目(WJ2015HB036)
【分類號】：R-332;R63
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