肺部感染铜绿假单胞菌耐药性与抗菌药物治疗效果研究
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姚振江

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R378.99+1R563.1

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广东省科技厅计划项目(2008B030301034)


Drug resistance and antimicrobial therapeutic efficacy of Pseudomonas aeruginosa in pulmonary infection
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    摘要:

    目的 分析广州地区肺部感染患者分离的铜绿假单胞菌(PA)耐药性及整合子携带情况,探讨其抗菌药物治疗效果及影响因素。方法 回顾性调查2008年9月—2010年12月广州市3所三级甲等医院呼吸内科确诊为PA肺部感染患者的病历资料。收集上述患者标本分离的PA菌株,检测其对常用抗菌药物的敏感性;采用聚合酶链反应(PCR)法扩增菌株整合子片段,分析整合子的类型;分析影响PA肺部感染患者预后的可能危险因素。结果共收集PA 114株,检出多重耐药菌47株(41.23%);71株(62.28%)PA检出Ⅰ类整合子。患者预后:21例(18.42%)治愈,63例(55.26%)好转,30例(26.32%)死亡。除庆大霉素、阿米卡星、妥布霉素、哌拉西林及哌拉西林/他唑巴坦外,Ⅰ类整合子阳性菌株对常用抗菌药物的耐药率明显高于Ⅰ类整合子阴性菌株(均P<0.05)。影响PA肺部感染患者预后的危险因素包括整合子阳性、多重耐药菌株、不适当的经验性治疗、联合使用3类或以上抗菌药物、混合感染、碳青霉烯类抗生素的使用,而联合使用2类抗菌药物是患者预后的保护因素。结论肺部感染患者分离的PA多重耐药率及Ⅰ类整合子携带率较高,整合子与耐药性关系密切,应加强监测。尽量避免使用碳青霉烯类抗生素进行经验性治疗;可联合使用2类抗菌药物进行抗感染治疗。

    Abstract:

    ObjectiveTo analyze drug resistance and distribution of integron in Pseudomonas aeruginosa (P. aeruginosa) isolated from patients with pulmonary infection, and evaluate antimicrobial therapeutic efficacy and influencing factors.MethodsClinical data of 114 patients with P. aeruginosa pulmonary infection in a hospital between September 2008 and December 2010 were reviewed retrospectively. P. aeruginosa isolated from above patients were performed antimicrobial susceptibility testing; the segments of integron were amplified by polymerase chain reaction; risk factors influencing the prognosis of P.aeruginosa pulmonary infection were analyzed.ResultsA total of 114 P. aeruginosa isolates were collected, 47(41.23%) were multidrugresistant strains; 71 (62.28%) were detected class Ⅰ integron. Patients’ prognosis were as follows:21 (18.42%) were cured, 63(55.26%) were improved, and 30(26.32%) died. Except gentamycin, amikacin, tobramycin, piperacillin and piperacillin/tazobactam, drug resistance rate of class Ⅰ integron positive strains was obviously higher than class Ⅰ integron negative strains(P<0.05). Factors influencing the prognosis of P.aeruginosa pulmonary infection included positive class Ⅰ integron,multidrugresistant strain, inappropriate empirical therapy, combination use of three or more types of antimicrobial agents,mixed infection and use of carbapenems, but combination use of two types of antimicrobial agents was the protective factor for prognosis.ConclusionMultidrug resistance rate and positive rate of class Ⅰ integron of P.aeruginosa are relatively high in pulmonary infection patients, integron is closely related to drug resistance, it is necessary to strengthen surveillance. Be sure to avoid using carbapenem for empirical treatment; combination of two types of antimicrobial agents for antiinfection treatment is recommended.

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毕嘉琦,周俊立,陈小凤,等.肺部感染铜绿假单胞菌耐药性与抗菌药物治疗效果研究[J]. 中国感染控制杂志,2013,12(2):92-96. DOI:10.3969/j. issn.1671-9638.2013.
BI Jiaqi, ZHOU Junli, CHEN Xiaofeng, et al. Drug resistance and antimicrobial therapeutic efficacy of Pseudomonas aeruginosa in pulmonary infection[J]. Chin J Infect Control, 2013,12(2):92-96. DOI:10.3969/j. issn.1671-9638.2013.

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  • 收稿日期:2012-07-12
  • 最后修改日期:2012-09-22
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  • 在线发布日期: 2013-03-30
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