阿奇霉素对ICU老年下呼吸道多药耐药铜绿假单胞菌感染的前瞻研究

A prospective controlled study of azithromycin on lower respiratory tract infections caused by multi-drug resistant pseudomonas aeruginosa in the elderly in intensive care unit

目的:评价阿奇霉素对ICU老年下呼吸道多药耐药铜绿假单胞菌(MDRP)感染的抗生素耐药性、细菌清除率和临床疗效的作用。方法:ICU老年下呼吸道MDRP感染患者30例,随机分为阿奇霉素干预组(实验组)和常规治疗组(对照组),两组均以抗铜绿假单胞菌的两种敏感抗生素(β内酰胺类联用氟喹诺酮类或氨基糖苷类)为基础治疗,实验组加用阿奇霉素0.5g/d,疗程21d。将治疗前后经纤支镜获得的下呼吸道分泌物标本,分别按氨基糖苷类、β内酰胺类、喹诺酮类等抗生素进行细菌敏感性及耐药情况分析,并观察细菌清除率和临床疗效。结果:实验组治疗后的氨基糖苷类的耐药率显著低于治疗前(χ2=5.12,P=0.024)和对照组(χ2=9.87,P=0.02);实验组临床总有效率为85.7%,显著高于对照组的35.7%(χ2=5.39,P=0.02),其细菌清除率为78.6%,高于对照组的57.1%,但差异无显著性(χ2=3.493,P=0.062)。结论:阿奇霉素在老年ICU下呼吸道MDRP感染的治疗中,作为敏感抗生素的辅助用药,可以降低氨基糖苷类抗生素的耐药率,显著提高临床总有效率。

Objective To investigate the effect of azithromycin on antibiotic resistance, clinical and bacterial efficacy in the adjuvant treatment of lower respiratory tract infections caused by multi-drug resistant pseudomonas aeruginosa （MDRP） in the elderly in intensive care unit （ICU）. Methods 30 elderly patients with MDRP lower respiratory infections were randomly enrolled into azithromycin group or control group （n=15）. Both groups received the same antibiotic therapy except azithromycin （0.5g ivgtt, per day） in the azithromycin group. The antibiotic resistance of aminoglycosides, β-lactams and quinolones in MDRP separated from the samples of lower respiratory tract by bronchofibroscope were detected at the baseline and 21 days after treatment. The clinical efficacy rates and bacteria eradication rates after treatment was also analyzed. Results The antibiotic resistance of aminoglycosides decreased significantly in azithromycin group after azithromycin treatment compared with that at baseline （4.8% vs. 17.8%, P=0.024） and that of control group （4.8% vs. 22.6%, P=0.02）. The overall clinic efficacy rates were higher significantly in azithromycin group than those in control group （85.7% vs. 5.7%, P=0.02）. The bacterial eradication rates were 78.6% in azithromycin group and 57.1% in control group. There was no significant difference between the two groups （P=0.062）. Conclusion Azithromycin, as an adjuvant drug, can decrease antibiotic resistance of aminoglycosides in MDRP, and increase the clinic efficacy in the therapy of lower respiratory tract infections caused by MDRP in the elderly in ICU, which may caused by inhibition of formation of bacterial biofilm.