强化抗菌药物治疗对泛耐药鲍氏不动杆菌感染的治疗评价  

Evaluation on intensive antibiotic treatment of PDRAB infection

作　　者：孙中霞[1] 朱团结[1] 黎宁君[1] 吴长江[1] 黄超发 隋明亮 刘会平[1] 

机构地区：[1]上海交通大学医学院附属苏州九龙医院重症医学科,江苏苏州215021

出　　处：《中华医院感染学杂志》2016年第4期739-741,共3页Chinese Journal of Nosocomiology

基　　金：苏州市工业科技孵化基金资助项目(ChiCTR-TRC-11001374)

摘　　要：目的探讨泛耐药鲍氏不动杆菌感染的临床治疗策略,以控制泛耐药鲍氏不动杆菌的感染。方法选择2009年6月-2013年6月医院获得性泛耐药鲍氏不动杆菌感染患者86例,A组32例患者采用头孢哌酮/舒巴坦单药延时输注,B组33例患者采用头孢哌酮/舒巴坦联合美罗培南治疗,C组21例患者采用头孢哌酮/舒巴坦联合替加环素治疗,于第5、10天观察患者体温、血像的变化,评价延长抗菌药物输注时间和抗菌药物联用对泛耐药鲍氏不动杆菌的治疗作用。结果与治疗前比较,患者接受强化抗菌药物治疗后第5、10天肛温及血细胞计数均呈显著降低,差异有统计学意义(P<0.01);患者初始治疗后第5、10天有效率分别为66.7%、83.3%;患者始末治疗有效率分别为73.9%、82.6%,经χ2检验,差异无统计学意义;C组患者第5、10天强化抗菌药物治疗有效率分别为95.2%、100.0%,显著高于A组的59.4%、78.1%及B组的78.8%、87.9%,差异有统计学意义(P<0.05)。结论头孢哌酮/舒巴坦延时输注,能有效地改善泛耐药鲍氏不动杆菌感染的疗效,当头孢哌酮/舒巴坦联用替加环素疗效更佳,而头孢哌酮/舒巴坦联用替加环素优于联用美罗培南。OBJECTIVE To discuss the clinical strategy for treatment of pan drug resistant Acinetobacter baumannii（PDRAB）infection so as to control this infection.METHODS In an open,parallel experimental design,86 patients with nosocomial pneumonia caused by PDRAB during Jun.2009 to Jun.2013 were divided into group A（n=32）,group B（n=33）and group C（n=21）.The patients in group A were treated with cefperazone/sulbactam（suiperazone,SPZ）alone by means of lengthening the infusion time.The patients in group B were treated with SPZ combined with meropenem（MEC）.The patients in group C were treated with SPZ combined with tigecycline（tygacil）.The treatment course lasted for ten days.The three groups were compared for changes in temperature and hemogram to evaluate the clinical effect of extended antibiotic infusing time and antibiotic combination for treatment of PDRAB.RESULTS The anal temperature and the blood cell count were significantly decreased at5 and 10days after the intensive treatment compared to those before treatment（P〈0.01）.The total effective rate for the three groups was 66.7% at 5days and 83.3% at 10 days after initial treatment.The effective rates of initial treatment and final treatment were 73.9%and 82.6%respectively.The effective rate for group C was 95.2%at 5days and 100.0% at 10 days after the intensive treatment,significantly higher than 59.4% and 78.1% for group A and 78.8% and 87.9% for group B（P〈0.05）.CONCLUSION Cefoperazone-sodium（SPZ）by means of lengthening the infusion time can effectively treat PDRAB infection,and it works quicker when combined with MEC.And the clinical curative effect of SPZ combined with tygacil to treat PDRAB infection is better than with MEC.

关 键 词：鲍氏不动杆菌 抗菌药物 头孢哌酮/舒巴坦 美罗培南 替加环素 

分 类 号：R453.2[医药卫生—治疗学]