湿疹皮炎皮损菌群测定与抗感染治疗研究

Detection of bacteria from skin in eczema patients and antiinfective treatment

摘要:

目的了解湿疹皮炎皮损处细菌学（尤其是金黄色葡萄球菌）特点及其药敏情况，探讨抗感染治疗在治疗湿疹皮炎中的作用。方法对某院100例湿疹皮炎患者靶皮损及60例健康对照者前臂皮肤进行采样细菌培养及药敏试验；将细菌培养阳性患者分为实验组和对照组（各44例），对照组口服氯雷他定，外用卤米松乳膏；实验组加用敏感抗菌药物克林霉素棕榈酸酯分散片口服，比较两组疗效。结果100例湿疹皮炎患者皮损处细菌和金黄色葡萄球菌检出率分别为88.00%、58.00%，明显高于健康对照者的66.67%和6.67%（均P＜0.01)。皮损处来源的金黄色葡萄球菌对青霉素耐药率（87.93%）最高，其次为红霉素（68.97%）和四环素（62.07%）等；对米诺环素、万古霉素、夫西地酸及呋喃妥因的敏感率则达100.00%。实验组痊愈率（40.91%）及显效率（81.82%）均显著高于对照组（分别为18.18%、54.55%），差异有统计学意义（均P＜0.05）。实验组细菌清除率为93.18%，显著高于对照组的59.09%（χ2=14.07，P＜0.01）；金黄色葡萄球菌清除率，实验组为93.10%（27/29），对照组为68.97%（20/29），差异有统计学意义（χ2=5.50，P=0.019）。两组均未见不良反应。结论湿疹皮炎与细菌（尤其是金黄色葡萄球菌）感染密切相关；加强对湿疹皮炎细菌的耐药性监测，有助于指导临床治疗用药，提高临床疗效，缩短病程。

Abstract:

ObjectiveTo explore the characteristics and antimicrobial susceptibility of bacteria (especially Staphylococcus aureus) isolated from skin lesion of eczema patients,and evaluate the effect of antiinfective therapy on eczema. MethodsSpecimens taken from lesion secretion of 100 eczema patients and forearm skin of 60 healthy control were performed bacterial culture, and the isolated bacteria were performed antimicrobial susceptibility testing, 88 eczema patients with positive bacterial culture of lesion were randomly divided into experimental and control group, control group was treated with oral loratadine plus external use of Halometasone cream, experimental group was treated with the method of control group plus sensitive antimicrobial agents clindamycin palmitate dispersible tablets, the therapeutic effect between two groups was compared. ResultsThe detection rate of total bacteria and Staphylococcus aureus from lesion of eczema patients was higher than healthy control respectively (88.00% vs 66,67%, P<0.01; 58.00% vs 6.67%, P<0.01). Drug resistance rate of Staphylococcus aureus from skin lesion to penicillin, erythromycin, and tetracycline was 87.93%，68.97% and 62.07% respectively; the sensitive rate to minocycline, vancomycin, fusidic acid, and furadantin were all 100.00%. The cure rate and effective rate of experimental group was higher than that of control group respectively (40.91% vs 18.18%, P＜0.05; 81.82% vs 54.55%, P＜0.05）. Total bacterial clearance rate and Staphylococcus aureus clearance rate of experimental group was higher than that of control group respectively (93.18% vs 59.09%, χ2=14.07，P＜0.01；93.10%［27/29］vs 68.97%［20/29］，χ2=5.50，P=0.019）.No side effect was found in two groups.ConclusionEczema is closely related to bacterial infection, especially Staphylococcus aureus infection; monitor on drug resistance is helpful to guide clinical antimicrobial use, improve clinical efficacy and shorten the course of disease.