不同抗菌药物对ICU泛耐药鲍氏不动杆菌感染的临床疗效对比分析  

Comparative analysis of clinical effects of different antibiotics on treatment of pandrug-resistant Acinetobacter baumannii infection in ICU

作　　者：郭丰义[1] 沈玉莲[2] 吴胜本[1] 丁宝忠[3] 郭山春[4] 

机构地区：[1]滨州市人民医院药学部,山东滨州256610 [2]滨州市人民医院骨三科,山东滨州256610 [3]滨州市人民医院普外科,山东滨州256610 [4]滨州市人民医院儿一科,山东滨州256610

出　　处：《中华医院感染学杂志》2016年第6期1226-1228,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然科学基金资助项目(2014ZRB14421)

摘　　要：目的研究ICU泛耐药鲍氏不动杆菌（PDRAB）感染应用不同抗菌药物治疗的临床效果,为临床治疗提供理论依据。方法选择2013年6月-2015年6月医院ICU诊治的40例发生PDRAB感染患者,40例PDRAB感染患者均应用头孢哌酮/舒巴坦进行治疗,其中18例患者应用大剂量药物进行单独治疗,每天9~12g,22例患者联合左氧氟沙星或者米诺环素进行治疗,疗程（13.3±5.3）d;有10例患者经治疗后效果不佳改为多黏菌素E单独进行治疗,疗程（16.9±5.0）d;分析PDRAB感染患者临床特点、抗菌药物的选择以及临床治疗效果。结果 40例患者通过深静脉导管、血液、脓液、支气管灌洗液、胆汁、引流液以及创面等标本中检测出40株PDRAB,其中有18例为多部位感染;40例PDRAB感染患者经治疗后,临床总有效率40.0%、细菌清除率32.5%及病死率为22.5%。结论 PDRAB感染患者采用大剂量头孢哌酮/舒巴坦或者联合米诺环素治疗的临床效果显著,是首选的国内治疗PDRAB的一种方法,PDRAB感染采用多黏菌素E治疗的临床效果也较好,能够将其列为治疗PDRAB感染的有效治疗方法中。OBJECTIVE To observe the clinical effects of different antibiotics on treatment of pandrug-resistant Acinetobacter baumannii（PDRAB）infection in ICU so as to provide theoretical basis for the clinical treatment.METHODS A total of 40 patients with PDRAB infection who were treated in the ICU from Jun 2013 to Jun 2015 were enrolled in the study,all of the 40 patients with PDRAB infection were treated with cefoperazone-sulbactam,of whom 18 were given high dose for single therapy,9-12 g every day,and 22 were treated with cefoperazone-sulbactam combined with levofloxacin or minocycline,with the treatment course（13.3±5.3）days.Totally 10 patients were treated with replacement of polymyxin E due to the poor therapeutic effect,with the treatment course（16.9±5.0）days.The clinical characteristics,use of antibiotics,and clinical therapeutic effect of the patients with PDRAB infections were observed.RESULTS Totally 40 strains of PDRAB were isolated from the deep venous catheter,blood,pus,bronchoalveolar lavage fluid,bile,drainage fluid,and wound secretions that were obtained from the 40patients;18patients had multiple sites of infections.The total effective rate of clinical treatment of the 40 patients with PDRAB infection was 40.0%,the bacterial clearance rate 32.5%,the mortality rate 22.5%.CONCLUSION The high dose of cefoperazone-sulbactam or combination with minocycline can achieve significant clinical effect on treatment of the patients with PDRAB infection,and it is the preferred choice for the treatment of PDRAB infection in China.Polymyxin E can also achieve significant clinical effect on treatment of the PDRAB infection,and it is an effective way to treat the PDRAB infection.

关 键 词：抗菌药物 重症监护病房 泛耐药鲍氏不动杆菌感染 治疗效果 临床分析 

分 类 号：R378.99[医药卫生—病原生物学]