重症监护病房洋葱伯克霍尔德菌肺部感染及耐药性分析  

Pulmonary infection and antimicrobial resistance of Burkholderia cepaciain intensive care unit

作　　者：陈裕胜[1] 黄昭[1] 程园园[1] 林材元[1] 

机构地区：[1]广东省广州市第一人民医院中心重症监护病房,广州510180

出　　处：《临床医学》2009年第5期1-3,共3页Clinical Medicine

摘　　要：目的探讨重症监护病房（ICU）洋葱伯克霍尔德菌肺部感染的临床特点及病原菌耐药情况及其防治措施。方法对2005年1月至2008年11月在ICU住院期间,28例洋葱伯克霍尔德菌院内肺部感染病例进行回顾性分析。结果本组病例多发生于老年人,有多种原发病或伴随疾病;感染患者往往病情突然加重,痰量明显增多,肺部渗出短期内明显增加;19种抗菌药物药敏试验结果显示复方磺胺甲基异噁唑、美罗培南、哌拉西林/他唑巴坦、头孢吡肟和头孢他啶的体外活性较高,在85%以上;其次为哌拉西林,敏感率为71.4%,头孢曲松、左氧沙星敏感率在50%－60%之间,环丙沙星敏感率为36%,其余均〈30%。结论洋葱伯克霍尔德菌具有多重耐药性,治疗难度大,应引起足够重视,需根据药敏试验结果选用敏感药物,如美罗培南、复方磺胺甲基异噁唑、哌拉西林/他唑巴坦、头孢他啶和头孢吡肟等。Objective To evaluate the clinical characteristics and bacterial resistance of pulomonary infections caused by Burkholderia cepaciain in intensive care unit and discuss how to control such infections. Methods The clinical data of 28 cases discharged from January. 2005 to November. 2008 were reviewed. Results Such nosocomial pulmonary infection caused by Burkholderia cepacia were commonly seen in older patients. Patients usually had some underlying diseases. Infectious patients generally presented as suddenly progressive condition, companied with increased sputum production and radiographic pulmonary infiltrate in a short period. Among the 19 antimicrobial agents tested, TMP - SMZ, meropenem, piperacillin - tazobactam, cefepime and ceftazidime were the most active. The susceptibility rates of piperacillin were 71.4%. However, Burkholderia cepacia isolates were resistant to other agents tested. Conclusion Susceptibility of Burkholderia cepaeia antimicrobial agents indicated that attention should be paid to muhidrug resistance in ICU. Rational use of antibiotics are very important in managing pul- monary infections caused by Burkholderia cepacia. Meropenem, TMP - SMZ, piperacillin - tazobactam, ceftazidime and cefepime are of choice for the treatment of Burkhotderia cepacia infections.

关 键 词：洋葱伯克霍尔德菌 医院肺部感染 重症监护病房 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R516[医药卫生—临床医学]