绿脓杆菌下呼吸道感染的细菌耐药性及抗菌治疗

目的提高合理应用抗菌药物及控制院内感染的水平。方法调查461株院内感染致病菌的分布、绿脓杆菌对抗菌药物的耐药率、耐药趋势、抗菌药物的敏感试验、最低抑菌浓度(MIC)、药动学、药效学、细菌清除率及不良反应。结果绿脓杆菌是北京医院院内感染主要致病菌、也是北京市5个综合医院感染病人的主要致病菌。32株院内感染绿脓菌株对抗菌药物耐药率如下:Gentamicin(GM)、Amikacin(AK)及Piperacillin(PIP)50％～56％、Ceftazidime(CAZ)及Sulperazon(SUPZ)18.8％,tienam(泰能)12.5％,Ciprofloxacin(CIP)6.5％。MIC(mg/L) 值如下:CIP 0.25～4,CAZ泰能4～32。从32株中的8株绿脓菌株中提取到耐药质粒。PIP治疗中度下呼吸道感染(下感)病例有效率63.3％,CIP及CAZ治疗重度下感病例的有效率各为75％及80％,泰能对耐CAZ或CIP的严重绿脓杆菌败血症并重症肺炎的有效率为76.6％。结论本研究揭示绿脓杆菌为综合医院特别是呼吸病房院内感染的主要致病菌;耐药的绿脓杆菌感染常致严重后果,是医疗中重要难题。监测细菌耐药性及对抗菌药物作出疗效评价,将为合理用药及经验治疗提供科学依据。

fDrug - resistance of pseudomonas aeruginosa and treatment in lower respiratory tract infections.

Objective To raise the level of reasonable use of antibiotics and control of nosocomial infections. Meth-ods To investigate the distribution of 461 pathogenic bacteria strains of nosocomial infections and the drug - resistant rates, drug - resistant trend, drug - sensitivity tests, mininum inhibitory concentration (MIC), pharmacokinetics, pharmacody-namics, eradication rate and side - effect of antibioticts of against Pseudomonas aeruginosa (PA) . Results PA were pri-mary pathogens of Beijing Hospital and 5 general hospitals in Beijing. The drug- resistant rates of 32 PA strains to antibiotics in table 3 as follows: CM. AK and PIP 50% - 56% , CAZ and SUPZ 18. 8% , tienam 12. 5% , CIP 6. 5% . MIC (mg/L) were as follows: cip 0. 25 - 4, CAZ and tienam 4 - 32, drug - resistant plasmids were abstracted from 25 % of PA which were isolated from above 32 patients with nosocomial infections, efficacy rate of pip in the patients with moderate PA infections were 63. 3% , CIP and CAZ in the patients with severe PA infections were 75% and 80% respec- tively while tienam was 76 . 6% in patients with PA. Septicemia which were CAZ - resistant or CIP - resistant. Conclusions The study revelation PA were primary pathogens of nosocomial infections of general hospital, especially inrespiratory ward. Patients admitted to the hospital were in high risk of life - threatening for developing nosocomial infection. The spread of resistant PA strains to commonly used antibiotirs woule result in increasing severity of infections. Control and surveillance the drug - resistant and spreading of bacterial infections and the evaluation of efficacy of antibiotics can be used as a guideline for the rational adminstration of effective antimicrobial drugs to the patient suffering from such infections which were scientific according to empirical antimicrobial chemotherapy without awaiting laboratory results.