Wewalka G, Koller W, Rotter M, Lackner F, Coraim F, Pichler H
Infection. 1976;4(4):204-10. doi: 10.1007/BF01638925.
133 patients in an intensive care unit, who prior to admission had not shown any signs of bacterial infection and had not received antibiotic treatment, were assigned to two groups at random. One group received antibiotic prophylaxis with penicillins or cephalosporins (+Pat.), the other group did not receive antibiotics (-Pat.). Staph. aureus was the most frequent facultative pathogen in tracheal secretions and in the environment of "-Pat.". This organism was significantly more frequent in "-Pat." than in "+Pat." in both the tracheal secretions and the environment. Klebsiella spp. outnumbered all other species in "+Pat.". They were significantly more frequent in tracheal secretions of "+Pat." than of "-Pat.". In the first week of hospitalisation marked changes were seen in bacterial flora of tracheal secretions of "+Pat.". Colonization with grammnegative bacteria rose to nearly 100%, the frequency of Staph. aureus diminishing at the same time. Monitoring by contact cultures revealed that gramnegative rods were significantly more numerous in the environment of "+Pat." than of "-Pat.". Matching bacterial strains cultured from tracheal secretions and from the environment of the patients proved that "+Pat. spread significantly higher numbers of their gramnegative bacteria into the environment. The same is true of "-Pat." for Staph. aureus. Intubation had no noticeable effect on the degree of contamination of the surroundings with Staph. aureus. Gramnegative rods were significantly more frequent in tracheal secretions of patients with intubation than in patients without. The same trend was observed for environmental contamination. As the clinical results of this study have shown, antibiotic prophylaxis does not protect patients from infections to the extent expected. Patients, and particularly intubated patients, receiving antibiotic treatment have to be considered as sources of highly resistant gramnegative organisms.
重症监护病房的133名患者在入院前未表现出任何细菌感染迹象且未接受过抗生素治疗，他们被随机分为两组。一组接受青霉素或头孢菌素的抗生素预防治疗（+Pat.），另一组不接受抗生素治疗（-Pat.）。金黄色葡萄球菌是“-Pat.”组气管分泌物和环境中最常见的兼性病原菌。在气管分泌物和环境中，该菌在“-Pat.”组中的出现频率均显著高于“+Pat.”组。克雷伯菌属在“+Pat.”组中数量超过所有其他菌种。它们在“+Pat.”组气管分泌物中的出现频率显著高于“-Pat.”组。在住院的第一周，“+Pat.”组气管分泌物的细菌菌群出现了明显变化。革兰氏阴性菌的定植率上升至近100%，同时金黄色葡萄球菌的频率降低。通过接触培养监测发现，“+Pat.”组环境中的革兰氏阴性杆菌数量显著多于“-Pat.”组。从患者气管分泌物和环境中培养出的匹配细菌菌株证明，“+Pat.”组向环境中传播的革兰氏阴性菌数量显著更多。“-Pat.”组的金黄色葡萄球菌也是如此。插管对周围环境中金黄色葡萄球菌的污染程度没有明显影响。插管患者气管分泌物中的革兰氏阴性杆菌明显多于未插管患者。环境污染也观察到了相同的趋势。正如本研究的临床结果所示，抗生素预防并不能如预期那样保护患者免受感染。接受抗生素治疗的患者，尤其是插管患者，必须被视为高耐药革兰氏阴性菌的来源。
