31例危重型甲型H1N1流感继发感染及耐药分析  

31 cases of critical influenza A(H1N1) influenza of secondary infection and drug resistance

作　　者：徐艳利[1,2] 蒋荣猛[1,2] 陈志海[1,2] 张伟[1,2] 王晓杰[1,2] 皇甫竞坤[1,2] 王京京[1,2] 李兴旺[1,2] 

机构地区：[1]北京地坛医院感染二科,北京100015 [2]北京地坛医院感染中心,北京100015

出　　处：《中华医院感染学杂志》2011年第5期864-866,共3页Chinese Journal of Nosocomiology

基　　金：国家科技支撑项目

摘　　要：目的分析危重型甲型H1N1流感继发细菌、真菌感染的特点、治疗及转归情况研究，探讨继发感染的原因及治疗，提高危重型甲型H1N1流感的治愈率和生存率。方法选择医院收治的危重型甲型H1N1流感继发感染者的痰、气管分泌物、血、引流液和尿液培养出的病原微生物为研究对象，并对此作药敏分析。结果共31例患者继发感染，感染率为47．7％；发生时间为发病后第2～15天，继发感染的部位多位于肺部，感染菌谱以革兰阴性菌为主，40株，占47．6％，革兰阳性菌25株，占29．8％，真菌19株，占22．6％；前5位病原菌依次为白色假丝酵母菌、鲍氏不动杆菌、表皮葡萄球菌、粪肠球菌、肺炎克雷伯菌，鲍氏不动杆菌仅对黏菌素敏感，大肠埃希菌对碳青霉烯类抗菌药物均敏感，金黄色葡萄球菌、肠球菌属和表皮葡萄球菌对万古霉素、替考拉宁和利奈唑胺均敏感。结论继发病原菌感染则以革兰阴性菌感染为主，药敏结果是选择用药依据；细菌感染经验性用药首选喹诺酮类或第三代头孢菌素，如感染严重则加用碳青霉烯类或万古霉素，对真菌感染者应采取积极抗真菌治疗。OBJECTIVE To analyze the features, therapy and prognosis of the secondary bacterial and fungal infection of critically ill patients with pandemic 2009 influenza A （H1N1） and investigate the reasons and treatments of secondary infection, therefore elevating the curing rate of the critically ill patients. METHODS The results of the sputum, tracheal secretion, blood sample, drainage fluid and urine cultivation were collected by using prospective research method, then the antibiotic susceptibility was analyzed. RESULTS There were 31 （47. 6%） in 65 critically ill patients occurring to the secondary infection, median time of which was 6 days （2-15d） from first symptom onset. The vast majority of secondary infection was the lung, the main bacteria was Gramnegative （40, 47.6%）, the following was Gram-positive （25, 29.8%） and fungi （19, 22.6%）. The first five were Candida atbicans , Acinetobacter baumannii , Staphylococcus epidermidis , Enterococcus f aecalis , Klebsiella pneumonia. ABA was only sensitive to Colistin Sulfate, while escherichia coli was sensitive to carbapenem antibiotics and Staphylococcus aureus, enterococcus and S. epidermidis were sensitive to vancomycia, teicoplanin and linezolid. CONCLUSION The secondary infection was mainly caused by Gram-negative bacteria. The antibiotic selection chould pase on the results of the drug sensitivity tests; However, before the available of results of the drug sensitivity tests, the empirical selection of antibiotic should be firstly considered to use quinolones or third generation cephalosporins, if severe, it is necessary to use the combined carbapenem or vancomyein. It is imperative to perform the antifungal therapy for the fungal infection.

关 键 词：危重型甲型H1N1流感 继发感染 病原菌 耐药性 

分 类 号：R373.1[医药卫生—病原生物学]