多耐药铜绿假单胞菌下呼吸道感染临床分析

目的　分析耐亚胺培南和头孢他啶铜绿假单胞菌下呼吸道感染的临床特点和治疗对策。方法　对2 0 0 1年 1月至 2 0 0 3年 12月收住我院的 15例耐亚胺培南和头孢他啶的铜绿假单胞菌下呼吸道感染患者的临床表现及治疗进行回顾性分析。结果　 15例均患有基础疾病 ,以支气管扩张最多见 ,临床特点有发热 ,咳黄色粘稠痰 ,胸部 X线表现为小斑片状浸润阴影。 6株对亚胺培南、头孢他啶、环丙沙星和哌拉西林均耐药。 15例患者 2例治愈 ,5例好转 ,其治疗选用抗生素药物有亚胺培南 ,头孢他啶 ,头孢哌酮 舒巴坦 ,哌拉西林 舒巴坦 ,环丙沙星等 ,均为联合使用 ;2例无明显改善 ;6例患者死亡。结论　多药耐药铜绿假单胞菌 (MDRP)下呼吸道感染大多合并基础疾病 ;有住院时间长 ,反复多次住院 ,曾使用多种广谱抗生素的特点 ;治疗困难 ,病死率高 ,预后差。抗生素药物选择应避免选用亚胺培南。

Clinical analysis of lower respiratory tract infection by multidrug resistant Pseudomonas areuginosa

Objective To Analyze clinical manifestations and management of lower respiratory tract infection caused by multidrug resistant pseudomonas aeruginosa.Methods A retrospective study was performed on 15 patients(10 males and 5 females) with lower respiratory tract infection caused by multidrug resistant Pseudomonas aeruginosa between 2000 and 2003. Results All patients had underlying diseases and most of them had bronchiectasis.Clinical manifestations included cough(15/15),expectoration Conclusion(13/15)and fever(7/15).The chest X-ray revealed infiltrations in low lobes of the lungs.15 cases caused by Pseudomonas aeruginose were resistant to imipenem and ceftazidime.After treatment,9 of them survived and 6 died.Conclusions Lower respiratory tract infection caused by multidrug resistant Pseudomonas aeruginosa were often concomitant with various underlying diseases.Imipenem and ceftazidime should avoid being used in this circumstance.The prognoses of MDRP infection in lower respiratory tract infection is poor.