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

发布时间：2019-01-27 19:01

【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P0.05);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P0.05)。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,P0.05)。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。
[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 卤0. 05) log10CFU/mL] were significantly higher than those in the catheter group [(3. 12 卤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.
【作者单位】：长江大学;新疆医科大学第一附属医院;
【基金】：湖北省卫生和计划生育委员会基金项目(WJ2015HB036)
【分类号】：R-332;R63

【相似文献】