单一与联合用药对机械通气感染铜绿假单胞菌的耐药性差异及疗效比较  

Impact of single and combined medication therapy on drug resistance of Pseudomonas aeruginosainfections in patients undergoing mechanical ventilation and therapeutic effect

作　　者：滕国杰[1] 聂秀红[1] 杨强[1] 

机构地区：[1]首都医科大学宣武医院呼吸科,北京100053

出　　处：《中华医院感染学杂志》2013年第2期438-440,共3页Chinese Journal of Nosocomiology

摘　　要：目的分析单一用药与联合用药对机械通气患者下呼吸道感染铜绿假单胞菌产生耐药的风险差异,为临床治疗铜绿假单胞菌感染提供参考依据。方法 2007年1月-2011年6月92例痰培养为非多药耐药的铜绿假单胞菌的机械通气患者,单独使用头孢他啶治疗或头孢他啶联合阿米卡星治疗,观察两组患者耐药性产生的差异,同时以肺部感染评分监测两组患者感染控制状况。结果 92例患者中43例单独使用头孢他啶治疗,49例使用头孢他啶联合阿米卡星抗感染治疗;单因素分析结果显示,APACHEⅡ评分≥16分,分离出铜绿假单胞菌前1周内使用过亚胺培南/西司他丁治疗,是产生耐药性改变的高危因素(P<0.05);logistic多元回归分析显示,分离出铜绿假单胞菌前1周接受亚胺培南治疗是产生耐药性变化的独立危险因素;以肺部感染评分监测两组患者感染控制状况显示,联合用药组感染控制明显好于单独用药组。结论与单一用药相比,联合用药并不减少铜绿假单胞耐药风险,治疗前应用亚胺培南/西司他丁可以增加耐药风险,联合用药的感染控制明显优于单一用药。OBJECTIVE To analyze the risk of single and combination use of antibiotics to cause the drug resistance of Pseudomonas aeruginosa causing lower respiratory tract infections in the patients undergoing mechanical ventilation and compare the status of control of pulmonary infections in the two groups of patients so sa to provide basis for clinical teratment of P. aeruginosa infectioms. METHODS From Jan 2007 to Jun 2011, 92 patients undergoing mechanical ventilation, whose sputum were collected and the non-multidrug-resistant P. aeruginosa strains were isolated and enrolled in the study. The patients were treated with,single ceftazidime or ceftazidime combined with amikacin, the difference in the drug resistance was compared. RESULTS Of 92 patients investigated, 43 patients were treated with single ceftazidime, and 49 received the combination of eeftazidime and amikacin. The univariate analysis indicated that the APACHE Ⅱ score more than 16 points and the treatment with imipenem within one week before the P. aeruginosa strains were the high risk factors for the chance of drug resistance, and logistic regression analysis showed that the treatment with imipenem within one week before the isolation of P. aeruginosa was the independent risk factor for the change of drug resistance. The pulmonary infections scoring monitoring displayed that the infection control of the combined medication group was significantly better than that of the single medication group. CONCLUSION As .compared with the single medication therapy ,the combined medication therapy can not reduce the risk of drug resistance of P. aeruginosa nor decrease the drug resistance to imipenem-xilastatin. The combined medication therapy is significantly superior to the single medication therapy in the infection control.

关 键 词：铜绿假单胞菌 耐药性 联合用药 单一用药 

分 类 号：R978.1[医药卫生—药品]