对亚胺培南耐药的铜绿假单胞菌引起的下呼吸道感染临床及细菌耐药分析

Retrospective analyses of clinical characters and resistance to imipenem of lower respiratory tract infections by Pseudomonas aeruginosa

目的:研究对亚胺培南耐药的铜绿假单胞菌引起的下呼吸道感染的临床特点和对常用抗生素的耐药性。方法:分析48例对亚胺培南耐药的铜绿假单胞菌引起的下呼吸道感染患者临床资料和采用K-B纸片扩散法进行抗生素药敏试验。结果:全部患者均有基础疾病,其中以慢性阻塞性肺疾病最常见(29%);长期应用广谱抗生素(100%)特别是应用亚胺培南(87·5%)、机体免疫力降低(75%)、接受各种侵入性操作是导致对亚胺培南耐药的铜绿假单胞菌感染的主要因素;常用药物中,仅对哌拉西林/他唑巴坦、头孢吡肟耐药率较低。结论:对亚胺培南耐药的铜绿假单胞菌多发生于有各种基础疾病、应用亚胺培南的患者,而且细菌耐药率高。

Objective： To evaluate the relationship of the symptomatic management to treatment resistance of lower respiratory tract infections （LRTI） caused by Pseudomonas aeruginosa that has a resistance to imipenem. Methods：The medical records of 48 patients with low respiratory tract infections caused by P. aeruginosa that is resistant to imipenem were retrospectively analyzed. Results： These patients experienced underlying diseases, of whom 29% suffered from COPD. These patients administered imipenem counted 87.5 % in the combinations of antibiotics regimens, leading to their immune suppression. In addition, various invasive measurements were at increased risk of developing the treatment resistance to imipenem of the patients with LRTI caused by P. aeruginosa. Piperacillin/tazobactam and cefepime effectively managed most of LRTIs Conclusion：The patients with underlying diseases who overused antibiotics to treat the LRTI had a higher incidence of the resistance of P. aeruginosa to imipenem.