重症监护病房患者泛耐药菌株的分布及相关因素分析

目的了解临床重症监护病房泛耐药细菌的分布,其产生的特定环境及高危因素,探讨预防及治疗策略。方法回顾性分析2008年4月-2009年4月两家医院重症监护病房（ICU）临床泛耐药细菌的菌种分布及高危因素。结果2008年4月-2009年4月,临床重症监护病房共有26例患者感染泛耐药细菌,菌株包括鲍曼不动杆菌10株、铜绿假单胞菌5株、洋葱伯克霍尔德菌4例、阴沟肠杆菌3株、嗜麦芽假单胞菌3株、肺炎克雷伯菌1株。广谱抗生素使用、老年患者、免疫功能低下、气管导管与呼吸机的使用是泛耐药细菌感染的高危因素。结论建立耐药监控体系,采用综合的抗菌药物治疗控制病原菌耐药;对于高危患者及早隔离,并限制碳青霉烯类抗菌药物的使用,以降低泛耐药病原菌的产生及发展。     

多重耐药革兰氏阴性菌肺部感染的治疗体会

目的分析我院呼吸科多重耐药(MDR)革兰氏阴性菌肺部感染的特点和治疗经验。方法回顾2009年1月至2010年12月本院呼吸科病房收治的48例MDR革兰氏阴性菌肺部感染患者的细菌学特点、抗菌药物选用及疗效。48例MDR革兰氏阴性菌肺部感染,检出鲍曼不动杆菌16株、铜绿假单胞菌14株、肺炎克雷伯菌10株、大肠埃希菌7株和阴沟肠杆菌2株,共49株革兰氏阴性菌。结果接受头孢哌酮/舒巴坦和碳青霉烯类抗生素治疗的患者分别为25例和21例,临床有效率分别为52.0%和61.9%,细菌清除率分别为36.0%和52.4%。结论呼吸科病房MDR革兰氏阴性菌肺部感染以鲍曼不动杆菌与铜绿假单胞菌为主,其中50.0%左右为泛耐药(PDR)菌株。头孢哌酮/舒巴坦对MDR特别是耐碳青霉烯类抗生素的铜绿假单胞菌、鲍曼不动杆菌肺部感染有一定的疗效,而碳青霉烯类抗生素对其敏感的革兰氏阴性菌肺部感染治疗效果比较好。     

老年ICU患者铜绿假单胞菌多药耐药易感因素分析

在老年重症监护病房(ICU)感染患者中,铜绿假单胞菌是院内感染的最常见致病菌,容易产生耐药,而且时常出现多药耐药(multidrug resistant,MDR),甚至广泛耐药[1-2],给治疗带来极大的困难。现对本院ICU收住的12例MDR铜绿假单胞菌患者及10例非MDR铜绿假单胞菌患者的相关因素进行比较     

铜绿假单胞菌耐药机制研究现状

铜绿假单胞菌是院内获得性感染的重要致病菌,在医院获得性肺炎（HAP）中占第二位,铜绿假单胞菌存在天然耐药,抗菌药物的应用及机械通气等环境的改变使铜绿假单胞菌出现获得性耐药及适应性耐药等复杂的耐药机制,并且产生多重耐药甚至泛耐药铜绿假单胞菌[1],显著增加了患者病死率及住院费用[2,3].     

成都地区老年人下呼吸道铜绿假单胞菌感染的耐药分析

目的 探讨成都地区老年人下呼吸道铜绿假单胞菌感染的耐药状况。方法 采集本院2011年1月~2013年12月356例符合老年人下呼吸道感染患者的痰标本,采用全自动微生物分析系统(VITEK-2 COMPACT)对铜绿假单胞菌进行分析。结果 2011年、2012年、2013年共分离出的356株铜绿假单胞菌对多粘菌素B的耐药率分别为1.65%、2.01%、1.11%。2011年分离出的121株铜绿假单胞菌对环丙沙星的耐药率较低,为20.66%。2012年分离出的145株铜绿假单胞菌对头孢吡肟的耐药率较低,为22.07%。2013年分离出的90株铜绿假单胞菌对阿米卡星的耐药率较低,为15.55%。结论铜绿假单胞菌是老年人下呼吸道感染常见病原菌,监测其耐药性,可为早期治疗控制感染提供依据,为减少并发症、延长患者生命提供保证。     

呼吸内科住院患者铜绿假单胞菌感染55例临床分析

目的了解呼吸内科住院患者铜绿假单胞菌感染的现状及耐药情况。方法分析我院呼吸内科55例铜绿假单胞菌感染患者的住院资料。结果我院住院患者铜绿假单胞菌感染耐药情况较严重,尤以院内感染PA更加明显。结论铜绿假单胞菌对常用抗生素耐药率较高,根据药敏结果选择合适的抗菌药物对提高临床疗效具有重要意义。     

泛耐药菌感染老年患者的细菌耐药性分析及其临床意义

目的分析泛耐药菌感染老年患者的细菌耐药性及其临床意义。方法对感染了铜绿假单胞菌和鲍曼不动杆菌的302例老年患者进行回顾性研究,收集病患者临床标本（痰、血、尿、胆汁、伤口等）,进行细菌鉴定和药敏实验;根据实验结果进行分组：泛耐药菌感染组和非泛耐药菌感染组。观察两组患者治愈率和死亡率并行组间比较;对泛耐药菌感染患者的基础疾病和用药情况进行分析。结果302例老年患者中检测出泛耐药菌感染患者34例（泛耐药菌感染组）和非泛耐药菌感染患者268例（非泛耐药菌感染组）。泛耐药菌感染组治愈率明显低于非泛耐药菌感染组（35％vs75．4％,P〈0．01）,死亡率却显著高于非泛耐药菌感染组（18％vs3．7％,P〈0．01）。结论泛耐药菌的耐药性对老年患者危害极大,应该采取有效措施加以解决。     

铜绿假单胞菌113株的耐药性分析

目的：分析铜绿假单胞菌对常用抗菌药物的耐药性,以指导临床对铜绿假单胞菌的合理用药。方法采用湖南天地人公司生产的TDR．200B细菌分析系统对临床标本中分离出的铜绿假单胞菌进行药敏试验,分析我院2010-02～2012-02分离的113株铜绿假单胞菌的耐药性。结果铜绿假单胞菌对19种常用抗菌药物的耐药率以亚胺培南最低（10.6％）,其次为阿米卡星（12.4％）;其中敏感株7株（6.2％）,多重耐药株25株（22.1％）,泛耐药株8株（7.1％）,其余耐药株73株（64.6％）。结论铜绿假单胞菌对19种常用抗菌药物存在不同的耐药性,应加强铜绿假单胞菌的耐药性监测,为临床合理选用抗菌药物提供依据。同时应对多重和泛耐药铜绿假单胞菌采取有效的预防措施,避免多重和泛耐药株的暴发流行。     

老年铜绿假单胞菌感染的临床特点及耐药性分析

目的探讨2015年我院老年患者铜绿假单胞菌感染的临床特点及耐药性,为临床治疗提供参考依据。方法收集2015年1~12月我院老年患者临床送检标本中分离出的铜绿假单胞菌233株,全部细菌严格按照《全国临床检验操作规程》进行分离与培养,采用Vitek 2 Compact全自动细菌鉴定和药敏分析系统进行细菌的鉴定及药敏试验,并用Excel软件进行数据统计分析。结果纳入研究的233株铜绿假单胞菌主要来源于痰液(72.10%),其余依次为尿液(7.73%),引流液(4.72%),全血(4.29%),导管(2.58%),腹水(2.58%),胆汁(2.15%),胸水(1.29%),切口分泌物(1.29%),咽刷、体液及脓液分别占0.43%;铜绿假单胞菌感染的主要科室是呼吸科和重症监护室,分别占33.05%及22.32%;铜绿假单胞菌对头孢曲松、头孢噻肟、头孢唑啉及头孢西丁等抗生素的耐药率达100%,对氨苄西林/舒巴坦和复方新诺明耐药率亦达100%,仅对少数β-内酰胺类、喹诺酮类及氨基糖苷类抗生素耐药率30%。结论老年患者铜绿假单胞菌感染以呼吸道感染为主,由于老年感染患者的临床用药存在局限性,加之铜绿假单胞菌对绝大多数抗生素都耐药,因此必须更加重视老年患者铜绿假单胞菌感染的有效预防与合理治疗。     

2012～2014年901株呼吸道铜绿假单胞菌药敏试验分析

目的铜绿假单胞菌是目前临床上较难清除的细菌之一。通过分析近3年从本院呼吸道标本分离的901株铜绿假单胞菌的体外药敏结果,汇总其耐药情况,以便更好地治疗铜绿假单胞菌引起的各种呼吸道感染。方法采用液体稀释法检测铜绿假单胞菌对17种抗菌药的MIC值,依据NCCLS/CLSI推荐标准分析药敏结果。结果铜绿假单胞菌对多粘菌素类制剂如多粘菌素B和多粘菌素E敏感性最好,敏感率分别为96.7%、95.9%。其次为哌拉西林/他唑巴坦,敏感率72.6%。阿米卡星敏感率70.4%,排第3位。头孢哌酮/舒巴坦敏感率67.6%,排第4位。其它头孢菌素类、碳青霉烯类、喹诺酮类和氨基糖苷类抗菌药敏感率均低于60%。结论铜绿假单胞菌对多粘菌素类制剂敏感性最好,对阿米卡星、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦也具有相对较好的敏感性,可经验性地用于治疗铜绿假单胞菌引起的呼吸道感染。     

铜绿假单胞菌肺部感染危险因素及耐药性分析

目的 分析铜绿假单胞菌(PAE)肺部感染危险因素及耐药性分析.方法 分析我院2007年1月～2011年4月101例肺部感染患者261株PAE株药物敏感性.结果 101例患者中有98例患者存在肺部或其它基础疾病,在261株菌株中除头孢三嗪外均有较高的药物敏感性及较低药物耐药性;其中对哌拉西林他唑巴坦药物敏感率最高,对环丙沙星药物耐药率最低;在有无肺部基础疾病药物敏感性分析中仅庆大霉素、环丙沙星、氨曲南、头孢三嗪、头孢他定药物有统计学意义在.结论 在PAE肺部感染中,肺部及其它各种基础疾病为其高危感染因素,但肺部疾病和基础疾病并不能成为药物敏感性变化因素的参考.     

Immediate and prolonged clinical efficacy of ceftazidime versus ceftazidime plus tobramycin in chronic Pseudomonas aeruginosa infection in cystic fibrosis

20 patients with cystic fibrosis and chronic bronchopulmonary infection due to Pseudomonas aeruginosa entered a randomized cross-over study comparing ceftazidime (150 mg/kg body weight/24 h) plus tobramycin (10 mg/kg body weight/24 h) to ceftazidime alone (150 mg/kg body weight/24 h), both given intravenously for 2 weeks. 17 patients completed the study; both treatment regimens improved lung function and decreased the WBC count. No difference in clinical efficacy was found between the treatments. Pulmonary function returned to pre-treatment levels 3 months later with no difference between the treatments. No changes were seen in minimal inhibitory concentrations during treatment. None of the patients developed hypersensitivity or experienced serious adverse reactions to the drugs.     

ICU肺部感染患者的病原菌及耐药性特点分析

目的探讨重症医学科(ICU)患者肺部感染致病菌分布情况及耐药性特点,以指导临床合理使用抗菌药物。方法2009年1月～2012年5月在我院ICU收治的128例肺部感染患者的痰病原菌细菌谱,并对药敏结果进行分析。结果共检出病原菌167株,其中革兰氏阴性菌139株,占83.2%,革兰氏阳性菌28株,占10.8%。其中革兰氏阴性菌最主要的病原菌依次是阴沟杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯氏菌。结论 ICU肺部感染患者的病原菌以革兰氏阴性菌为主,特点是多重耐药的阴沟杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯氏菌更显著,革兰氏阳性菌及念珠菌检出率不高,这对抗菌药物的合理使用具有指导意义。     

412例住院肺结核患者合并感染的致病菌分析

目的 探讨肺结核合并肺部感染的特点、致病菌的分布及药敏情况,为临床合理使用抗生素提供依据.方法 对天津市海河医院2004年5月至2007年12月的412例痰细菌培养发现致病菌的肺结核住院患者的痰培养结果进行回顾性分析.结果 412例患者共培养出致病菌858株.革兰阴性杆菌占68.6%,革兰阳性球菌占12.7%·真菌占18.6%.其中肺炎克雷伯菌、铜绿假单胞菌、白色念珠菌为主要细菌.药敏试验提示多数致病菌对未加β内酰胺酶抑制的青霉素耐药在78.6%～98.8%之间,对第一、二代头孢菌素等的耐药率在11.1%～97.4%之间,对一三代头孢类的耐药率在9.8%～70.6%之间,对碳青霉烯类抗生素敏感率较高.结论 肺结核合并下呼吸道感染以及耐药情况严重,因此在结核患者合并感染临床选用抗生素治疗时应以药敏试验为依据,选择合理有效的抗生素,减少盲目用药和不良反应的产生.减少耐药菌株的产生.     

住院结核病患者铜绿假单胞菌和鲍曼不动杆菌的检出率及药物敏感性分析

目的 了解结核病患者铜绿假单胞菌和鲍曼不动杆菌的检出率及药物敏感性试验结果,为探讨合理使用抗生素和控制医院感染提供依据。 方法 根据《全国临床检验操作规程》,收集广州市胸科医院2011年1月至2013年8月临床住院结核病患者共6493例的送检标本,标本包括痰液、支气管纤维镜冲洗液、胸或腹腔积液、伤口分泌物、血液等。以痰液标本为主,占77.91%（5059/6493）;支气管冲洗液次之,占13.52%（878/6493）,其他标本占8.56%（556/6493）。应用PHOENIX-100全自动微生物分析仪对细菌进行菌群鉴定和临床常用抗生素的药物敏感性试验。结果 6493例标本共分离出3612株临床分离株,其中铜绿假单胞菌985例,占总微生物的27.27%（985/3612）;鲍曼不动杆菌324例,占8.97%（324/3612）。其中铜绿假单胞菌对多黏菌素的敏感率达100.00%（985/985）、妥布霉素敏感率也在94.52%（931/985）,对氨苄西林-舒巴坦和头孢唑啉的耐药率均为99.39%（979/985）。鲍曼不动杆菌除了对多黏菌素高度敏感（100.00%,324/324）外,对其余常用抗生素均有不同程度耐药。 结论 铜绿假单胞菌和鲍曼不动杆菌对临床多种抗生素呈现耐受性,因此应根据药物敏感性试验结果合理选择抗生素,避免耐药菌株的产生。     

130例院内下呼吸道感染病原菌及耐药分析

目的分析住院患者下呼吸道感染病原菌分布特点及药敏。方法收集2007年-2009年130例呼吸内科及ICU住院患者痰或支气管灌洗液标本280例,对其中130例培养阳性菌株行荧光快速微生物鉴定及药敏分析。结果 G^-占59.2%,G^＋占30.1%,霉菌占10.7%。G^-以绿脓杆菌为主,耐药情况最严重。结论绿脓杆菌是院内感染最常见致病菌,COPD患者长期或多次住院,使用多种广谱抗生素均为耐药菌产生的危险因素,应重视定期做病原菌检测及耐药分析。     

Use of aztreonam in the treatment of serious infections due to multiresistant gram-negative organisms, including Pseudomonas aeruginosa

Aztreonam is a novel antimicrobial agent belonging to the monobactam class of antibiotics. It inhibits both beta-lactamase-producing and non-beta-lactamase-producing aerobic gram-negative bacilli, but it has no activity against gram-positive species or against anaerobic species. The efficacy of aztreonam in the treatment of infection in 76 patients and its safety in 87 patients was evaluated. The majority (91 percent) of patients had significant underlying disease, and 47 percent were critically ill. Aztreonam produced an overall clinical response of 86 percent, with 10 of 11 cases of bacteremia cured, including four due to Pseudomonas aeruginosa, seven of eight cases of pneumonia, and seven of nine episodes of osteomyelitis. Infections due to bacteria resistant to ampicillin, carbenicillin, cefazolin, cefamandole, cefoxitin, and gentamicin were cured. Although 15 of 18 patients with exacerbations of pulmonary infection due to P. aeruginosa showed clinical improvement, bacteriologic cure was not achieved, as has been noted with other drugs. Similarly, patients with major underlying structural abnormalities of the urinary tract showed early relapses of bacteriuria. Aztreonam combined with antistaphylococcal, antistreptococcal, or antianaerobic agents provided an alternative to aminoglycoside use in these non-neutropenic patients. Administration of 1 or 2 g every eight hours yield serum bactericidal levels well in excess of 1:8 against all Enterobacteriaceae and some P. aeruginosa strains. There was a low incidence of adverse side effects, none serious. Overall, aztreonam is a useful alternative to the drugs available for use in hospital-acquired gram-negative infections and provides a chance for more directed therapy.     

Addition of inhaled tobramycin to ciprofloxacin for acute exacerbations of Pseudomonas aeruginosa infection in adult bronchiectasis

RATIONALE: Pseudomonas aeruginosa lung infection in patients with bronchiectasis, a chronic airway disease that is characterized by episodes of exacerbation, is associated with more severe disease and a higher utilization of health-care resources. Inhaled tobramycin solution reduces the number of acute exacerbations in patients with cystic fibrosis (CF)-related bronchiectasis with P aeruginosa infection but remains untested in the treatment of exacerbations in patients with non-CF bronchiectasis. OBJECTIVES: This study tested the effect of adding inhaled tobramycin solution to oral ciprofloxacin (Cip) for the treatment of acute exacerbations of non-CF bronchiectasis in patients with P aeruginosa infection. METHODS: A double-blind, randomized, active comparator, parallel-design study conducted at 17 study centers (5 in the United Kingdom, and 12 in the United States) compared 2 weeks of therapy with Cip with either an inhaled tobramycin solution or placebo in 53 adults with known P aeruginosa infection who were having acute exacerbations of bronchiectasis. MEASUREMENTS: Clinical symptoms, pulmonary function, clinical efficacy, and sputum microbiology were investigated prospectively. Main results: An inhaled solution of Cip with tobramycin, compared to placebo, achieved greater microbiological response but no statistically significant difference in clinical efficacy at days 14 or 21. Clinical and microbiological outcomes at the test of cure (ie, the clinical outcome assessment at day 21) were concordant when an inhaled tobramycin solution was added to therapy with Cip and compared to placebo (p = 0.01). Both subject groups had similar overall adverse event rates, but subjects receiving therapy with an inhaled tobramycin solution reported an increased frequency of wheeze (50%; placebo group, 15%). CONCLUSIONS: The addition of an inhaled tobramycin solution to therapy with oral Cip for the treatment of acute exacerbations of bronchiectasis due to P aeruginosa improved microbiological outcome and was concordant with clinical outcome; the inability to demonstrate an additional clinical benefit may have been due to emergent wheeze resulting from treatment.     

A pilot study of the safety and efficacy of tobramycin solution for inhalation in patients with severe bronchiectasis

STUDY OBJECTIVE: To evaluate the efficacy and safety of tobramycin solution for inhalation (TSI) in patients with severe bronchiectasis. DESIGN: Open-label clinical trial consisting of three treatment cycles (14 days of drug therapy, and 14 days off drug) and an additional 40-week follow-up by chart review. SETTING: Nine clinical sites throughout the United States. SUBJECTS: Forty-one adult patients (>/= 18 years old) with diffuse bronchiectasis affecting two or more lung segments and a history of Pseudomonas aeruginosa infection. INTERVENTIONS: TSI, 300 mg tobramycin per dose bid. MEASUREMENTS AND RESULTS: During the 12-week treatment period, significant improvements (reduction of 1.5 U [p = 0.006]) occurred in mean pulmonary total symptom severity score, a composite score that assesses the severity of cough, shortness of breath, sputum production, fatigue, and wheezing. Significant improvements (reduction of 9.8 U [p < 0.001]) were also observed in St. George Respiratory Questionnaire scores, which measure health-related quality of life. Eradication or presumed eradication of P aeruginosa occurred in 6 of 27 evaluable subjects (22.2%). Tobramycin-resistant P aeruginosa developed in two subjects (minimal inhibitory concentration >/= 16 microg/mL). Ten subjects withdrew from the study due to adverse events; in nine of these subjects, adverse events were considered probably or possibly related to treatment. The most common adverse events were cough, wheezing, and dyspnea. CONCLUSIONS: TSI therapy resulted in significant improvements in respiratory symptoms and health-related quality of life in subjects with severe bronchiectasis, but some subjects did not tolerate TSI therapy. Bronchiectasis patients receiving this therapy should be monitored for signs of intolerance.     

Efficacy and safety of mizoribine for the treatment of Sjögren's syndrome: a multicenter open-label clinical trial

This multicenter clinical trial was performed to evaluate the efficacy and safety of mizoribine for the treatment of Sjögren's syndrome. Fifty-nine patients with a definite diagnosis of Sjögren's syndrome received 150^Smg of mizoribine daily for 16 weeks. The salivary secretion volume was determined at baseline, at weeks 8 and 16 after the start of the study treatment by the Saxon test, and clinical manifestations were assessed by the investigator and the patients using a 10-cm visual analog scale (VAS). Adverse drug reactions were reported in 18 patients, of whom 6 patients had to discontinue the study due to such adverse reactions; however, no serious adverse drug reactions definitely related to the study drug were noted. The salivary secretion volume, the rate of change in salivary secretion, the patients’ own assessments of dry mouth and dry eyes, the investigators’ assessment of oral sicca symptoms, and the investigators’ overall assessment improved following the treatment regimen with statistical significance at week 16 after the start of treatment in comparison to the baseline values. These results suggested that mizoribine may be effective in producing a subjective and objective amelioration of the glandular symptoms in patients with Sjögren's syndrome, without observing any serious adverse effects related to this drug.