抗生素治疗革兰氏阴性细菌感染诱导内毒素释放的临床研究

目的观察伊米配能/西司他丁(IPM)和头孢哌酮(CPZ)在治疗严重烧伤病人革兰氏阴性(G-)细菌感染过程中诱导内毒素(LPS)释放的情况.方法烧伤病人随机分为IPM组和CPZ组,分别于治疗第1天和第3天取创面分泌物和痂下组织做细菌培养和药敏试验,并于用药前(0)、用药后2、12、24、48、72 h抽静脉血测血浆LPS.结果两组烧伤病人均为G-细菌感染患者,抗生素治疗3 d后,痂下组织中细菌量降低1～2个数量级;血浆LPS在治疗后2 h都升高至峰值,CPZ组的LPS升幅大于IPM组,3 d后两组病人的LPS水平较治疗前都明显下降.结论 IPM和CPZ都能有效治疗G-细菌感染,同时诱导释放LPS,IPM组诱导释放的LPS低于CPZ组;LPS的释放量随着细菌量减少而逐渐降低.

Clinical study on antibiotic-induced endotoxin release in Gram-negative bacterial infection

Objective To observe the various influence of Imipenem/Cilastatin(IPM) and Cefoperazone(CPZ) on Gram-negative bacterial endotoxin release in severely burned patients.Methods Patients were divided into IPM group and CPZ group randomly. The bacterial cultures and microbial drug-sensitivities of burn wound swabs and subeschar tissues were performed on the 1st and 3rd day, At the same time, the levels of LPS in plasma were detected in seven burned patients administrated with IPM and six with CPZ at the time 0?2?4?12?24?48?72h of antibiotics administration.Results Patients were infected by Gram-negative bacterial. The counting of bacteria in subeschar tissues decreased 10~100 times after the administration of antibiotics 3 days; Plasma LPS levels elevated to the peak value at 2h after infusion of IPM or CPZ , and then showed significant decrease. The magnitude of increased LPS in CPZ group was higher than that in IPM group; The LPS levels of 72h were lower significantly than that of 0h.Conclusion IPM and CPZ could effectively control Gram-negative bacterial infection and induce the releases of LPS from bacteria, of which the former induced less LPS release than the latter; The levels of LPS came down with the decreasing of bacterial counting.