摘要
目的分析泛耐鲍曼不动杆菌(pandrug resistant Acinetobacter baumanii,PDRAB)感染的临床特征和治疗情况,探讨PDRAB感染的临床防治方法。方法选取2008年1-12月份我院9例经病原学及药敏试验证实PDRAB的临床感染病例,应用病例分析方法,分析其发生的高危因素及治疗结果。结果 (1)PDRAB感染主要发生在重症基础疾病患者,多合并有糖尿病或高血压等慢性病,有机械通气或手术或导管留置史,患者黏膜完整性破坏;(2)此类感染除对多粘菌素敏感率为100%外,对目前所有常规检测的抗菌药物耐药率均为100%;(3)此类感染目前主要是医院获得性感染,其感染部位主要在肺部,发生前患者均有较长的住院时间,均应用过抗菌药物,尤其是广谱抗菌药物应用比例高,以三代以上头孢菌素和喹诺酮类抗感染药物应用比例较高,考虑耐药菌的产生可能与广谱抗菌药的选择压力有一定关联。(4)使用碳青霉烯类或舒巴坦制剂或二者序贯使用同时联合米诺环素或喹诺酮类或氨基糖苷类有一定的治疗效果。结论泛耐的鲍曼不动杆近年在医院获得性感染中明显增加,尤其发生在有高危因素患者中;广谱抗菌药物的广泛使用可能与其发生有一定的关联;体外泛耐菌株使用碳青霉烯类或舒巴坦制剂或二者序贯联合其他药物治疗有一定的疗效。
Objectives To analyze clinical characteristics and therapy of pan-resistant Acinetobacter baumannii（PDRAB） infection and explore the methods for effective therapy and prevention of this infection.Methods Nine hospitalized patients with PDRAB infection confirmed by pathogen and susceptibility testing were analyzed for the risk factors and the treatment outcomes were assessed by case analysis.Results PDRAB infections occurred mainly in patients with severe complications,most of whom had complications by diabetes or hypertension or damaged mucosal integrity due to mechanical ventilation,surgery and catheterization.The polymyxin sensitivity were 100% forthese infections,but all the bacteria identified showed a antimicrobial resistance rates of 100%.The majority of the infections were acquired during hospitalization occurring mainly in the lungs;all the patients had prolonged hospitalization and received antibiotic treatments with high proportions of broad-spectrum antimicrobial agents especially third-generation cephalosporins and quinolones.Exclusive orsequential use of carbapenems and sulbactam in combination with quinolone or aminoglycoside produced favorable effects.Conclusions The prevalence of hospital-acquired pan-resistance of PDRAB infections increased significantly in recent years,particularly in patients with high risk factors.The widespread use of broad-spectrum antibiotics may have some relevance to drug resistant occurrence.The application of carbapenems or sulbactam,or their sequential use,in combination with other agents may produce good effects.
出处
《南方医科大学学报》
CAS
CSCD
北大核心
2010年第10期2351-2353,2359,共4页
Journal of Southern Medical University
关键词
泛耐药
鲍曼不动杆菌
医院感染
pan-drug resistant Acinetobacter baumannii nosocomial infection
