多黏菌素类药物雾化吸入治疗下呼吸道多重耐药革兰阴性菌感染中国专家共识(2024年版)  

Chinese expert consensus on aerosol inhalation of polymyxins in the treatment of multi-drug resistant Gram-negative bacterial infections of lower respiratory tract(2024 version)

作　　者：中国医药教育协会感染疾病专业委员会(IDSC) 俞云松[2] 施毅 周华[4] 曹清 佘丹阳[6] 陈德昌 张菁 叶枫 刘玲[10] 苏欣 胡必杰[12] Infectious Diseases Committee(IDSC)of China Association of Medical Education;Yu Yunsong;Shi Yi(不详;Zhejiang Provincial People’s Hospital/Affiliated People's Hospital of Hangzhou Medical College,Hangzhou 310014,China;Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China)

机构地区：[1]不详 [2]浙江省人民医院杭州医学院附属人民医院,杭州310014 [3]南京大学医学院附属金陵医院,南京210002 [4]浙江大学医学院附属第一医院 [5]上海交通大学医学院附属上海儿童医学中心 [6]中国人民解放军总医院 [7]上海交通大学医学院附属瑞金医院 [8]复旦大学附属华山医院抗生素研究所 [9]广州医科大学附属第一医院 [10]东南大学附属中大医院 [11]南京大学医学院附属鼓楼医院 [12]复旦大学附属中山医院

出　　处：《中华临床感染病杂志》2024年第5期353-366,共14页Chinese Journal of Clinical Infectious Diseases

摘　　要：下呼吸道感染是导致人类死亡的主要疾病之一,尤其是多重耐药鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌导致的医院获得性肺炎(HAP)和呼吸机相关性肺炎(VAP),碳青霉烯类抗菌药物耐药比例高,可供选择的抗菌药物有限,抗感染治疗疗效欠佳。多黏菌素类药物对大部分碳青霉烯类耐药革兰阴性菌体外敏感性高,但静脉给药后肺泡上皮衬液浓度低而影响其发挥临床疗效。国内外不断有临床实践和研究采用联合雾化给药方式以提高疗效,但目前关于多黏菌素类药物雾化吸入治疗下呼吸道感染的适应证、禁忌证、给药方案及雾化吸入装置的选择,以及不良反应的处理等问题仍无详细、规范的建议。因此,中国医药教育协会感染疾病专业委员会(IDSC)组织重症医学、呼吸病学、感染病学和临床药学等学科的著名专家共同编写本共识,凝练出临床常见的11个关键问题,在广泛查阅文献证据的基础上以问答的方式给出相应的答案,形成10条推荐意见,旨在为临床医师科学合理地应用雾化吸入多黏菌素类药物提供切实可行的参考。Lower respiratory tract infection is one of the leading causes of death.Especially,hospital acquired pneumonia(HAP)and ventilator-associated pneumonia(VAP)caused by muti-drug resistant Acinetobacter baumannii,Pseudomonas aeruginosa and Klebsiella pneumoniae have a high resistance rate to carbapenem antibiotics,with limited options for antimicrobial therapy and suboptimal efficacy in antimicrobial treatment.Polymyxins are highly susceptible to most carbapenem-resistant Gram-negative bacteria in vitro,but the low concentration in alveolar epithelial lining fluid after intravenous administration affects their clinical efficacy.To improve the efficacy,combined atomization administration has been widely studied and applied cliniacally at home and abroad,however,there are still no detailed and standardized recommendations on the indications,contraindications,standardized administration,atomizing inhalation device and adverse reactions of polymyxin atomizing inhalation for treatment of lower respiratory tract infections.Therefore,the Infectious Diseases Society of China(IDSC)invited experts in intensive care medicine,respiratory medicine,infectious diseases,clinical pharmacy and other disciplines to develop this consensus on the basis of extensive literature evidence.The consensus focuses 11 key issues commonly seen in clinical practice in question-and-answer forms,and presents 10 recommendations in order to provide a practical reference for clinicians to rationally apply aerosol inhalation of polymyxins for treatment of lower respiratory tract infections.

关 键 词：多黏菌素E甲磺酸钠 硫酸多黏菌素B 硫酸多黏菌素E 下呼吸道感染 多重耐药革兰阴性菌 雾化吸入 

分 类 号：R47[医药卫生—护理学]