免疫受损与非免疫受损患者下呼吸道铜绿假单细胞菌感染的临床对比  

A Comparative Study on the Clinical Manifestations of ICHs and Non-ICHs with Low Respiratory Tract Infections of Pseudomonas Aeruginosa

作　　者：邵长周[1] 瞿介明[1] 何礼贤[1] 倪才妹[1] 胡必杰[1] 

机构地区：[1]复旦大学附属中山医院肺科,上海200032

出　　处：《复旦学报（医学版）》2003年第6期537-541,545,共6页Fudan University Journal of Medical Sciences

基　　金：上海市卫生系统优秀学科梯队带头人培养计划"百人计划"(98BR030)资助项目

摘　　要：目的 对比研究药物所致免疫受损宿主(immunocompromised host,ICH)与非免疫受损宿主(non-im-munocompromised host,Non-ICH)下呼吸道铜绿假单胞菌(pseudomonas aeruginosa,PA)感染的临床表现、特点和耐药性。方法 总结5年内发生PA下呼吸道感染病例的药物所致ICH 106例和Non-ICH 227例,对自下呼吸道标本分离出的1421株PA(ICH 519株,Non-ICH 902株)的体外药敏活性进行统计分析。结果 ICH下呼吸道感染的PA标本来自气管镜检查较多(33.96％∶14.98％),侵袭性操作多,临床较多表现为咳嗽、咳痰(82.08％∶66.52％)和胸水(58.49％∶32.60％),X线表现明显(64.05％∶36.56％),多合并其他病原体感染(60.37％∶40.09％),细菌耐药率高,患者死亡率高(33.96％∶20.26％)。药敏试验:PA的抗生素耐药率依次为头哌酮/舒巴坦2.0％、哌拉西林/三唑巴坦3.8％、阿米卡星5.3％、头孢吡肟10.0％、头孢他啶11.3％、替卡西林/克拉维酸12.1％、亚胺培能12.9％等。ICH中多数抗生素如亚胺培能(27.1％∶4.7％)、哌拉西林/三唑巴坦(7.4％∶1.6％)和头孢哌酮/舒巴坦(3.2％∶1.2％)耐药率高,2000年后药物敏感性下降。结论 ICH基础疾病重,易感因素多,合并下呼吸道PA感染时临床表现和抗生素耐药率不同于Non-ICH,临床防治中应重视。Purpose: To study comparatively the antimicrobial susceptibility patterns and clinical manifestations of immuncocmpromised hosts (ICHs) resulting from immunosuppressive agents and non-immunocompromised hosts (Non-ICHs) infected with pseudomonas aeruginosa(PA) in low respiratory tact in order to assist the rational clinical prevention and treatment of PA eruginosa infection. Methods: Three hondred and thirty-three patients infected pseudomonas eruginosa including 106 ICHs and 227 Non-ICHs were included in this restrospective study. The clinical features and laboratory data of these patients were analyzed. Meanwhile, we in vestigated the antimicrobial susceptibility patterns of 1 421 PA aeruginosa strains (519 from ICHs and 902 from Non-ICHs) in different years. Results: Compared with Non-ICHs, ICHs had more risk factors, invasive treatments, other pathogens infections (60.37%, 40.09%) and more positive specimens coming from fibrobronchoscope (33.96%, 14.96%), mainly from aspiration and bronchoalveolar lavage. Patients in two groups had different clinical presentations, especially in radiological findings, leural effusions (58.49% in ICHs and 32.60% in Non-ICHs), cough and expectoration (82.08% in ICHs and 66. 52% in Non-ICHs). A high resistance rate of PA aeruginosa to common antibiotics was found in tow groups. Antimicrobial resistance was as follow: cefoperazone/sulbactam 2.0%, piperacillin/tazobactam 3.8%, amikacin 5.3%, cefepime 10.0%%, ceftazidime 11.3%, ticarcillin/clavulanicacid 12.1%, imipenem 12.9%, piperacillin 14.5%, cefoperazone 15.6%. In these five years, the susceptibility of PA aeruginosa to most antibiotics was lower in ICHs than that in Non-ICHs. They became lower after the year 200. The prognosis was poorer in ICHs than that in Non-ICHs. Conclusions: Compared with Non-ICHs, ICHs with low respiratory tract infections of PA had more risk factors and different clinical manifestations. The resistance rates of PA to different antibiotics were different.

关 键 词：免疫受损 非免疫受损 下呼吸道感染 铜绿假单细胞菌 耐药性 抗生素 药物敏感性 

分 类 号：R515[医药卫生—内科学] R56[医药卫生—临床医学]