泛耐药鲍曼不动杆菌所致呼吸机相关肺炎的临床疗效分析

目的 总结泛耐药鲍曼不动杆菌(PDR-Ab)感染的临床特点,分析不同抗菌药物对PDR-Ab所致肺部感染的治疗效果,为PDR-Ab肺部感染提供临床经验与治疗方案。方法 选取中国人民解放军总医院老年病区2009年4月至2010年4月老年呼吸机相关肺炎为研究对象,分离获取患者下呼吸道分泌物中PDR-Ab,并对其临床分布特征、药物敏感结果以及在此基础上进行的治疗及预后等方面进行回顾性分析。结果 在126例老年呼吸机相关肺炎患者中,42例以PDR-Ab为优势菌。A组20例应用头孢哌酮/舒巴坦联合米诺环素治疗,临床总有效率为65%,细菌清除率为40%。B组22例应用其他抗菌药物治疗,临床总有效率为22.7%,细菌清除率为13.6%。PDR-Ab培养阳性前住院天数和机械通气时间是影响细菌清除的主要因素(P均＜0.01)。结论 头孢哌酮/舒巴坦联合米诺环素对PDR-Ab引起的下呼吸道-肺感染具有一定疗效,该治疗方案在临床应用中具有重要的实际意义。

Preliminary Analysis on the Treatment of Ventilator-associated Pneumonia Caused by Pandrug-resistant Acinetobacter Baumannii

Objective To analyze the clinical features of pandrug-resistant Acinetobacter baumannii(PDR-Ab)in the Chinese PLA General Hospital and compare the efficacies of different antibiotic treatments in aged patients with ventilator-associative pneumonia(VAP)caused by PDR-Ab.Methods Data were collected from all isolated PDR-Ab strains in our hospital from April 2009 to April 2010.The clinical features,treatment,and outcomes were retrospectively reviewed.Results PDR-Ab was found to be the dominant pathogen in 42 of 126 aged VAP patients.Cefoperazone/sulbactam plus minocycline showed good efficacy in 20 patients with PDR-Ab VAP,showing a clinical cure rate of 65%(13/20)and a bacterial eradication rate of 40%(8/20).Another 22 patients were treated with other antimicrobial drugs,achieving a clinical cure rate of 22.7%(5/22)and a bacterial eradication rate of 13.6%(3/22).The factors influencing bacterial clearance were prolonged length of hospital stay and mechanical ventilation prior to positive culture(all P＜0.01).Conclusion Cefoperazone/sulbactam plus minocycline can be an effective treatment for VAP caused by PDR-Ab.