泛耐药鲍曼不动杆菌感染临床治疗初探

Preliminary analysis on the treatment of infection caused by pandrug-resistant Acinetobacter baumannii

目的总结我院泛耐药鲍曼不动杆菌(PDR-Ab)感染的临床及实验室特点,分析不同抗菌药物对肺部感染的治疗效果,为治疗PDR-Ab感染提供参考资料。方法收集我院2004年2月至2005年3月间分离的PDR-Ab,对其临床特征、治疗及预后进行回顾性总结分析。结果分离出77株,其中属定植菌者32株,属感染菌者45株(下呼吸道35株、血流性6株、胸腹腔引流液共3株、伤口分泌物1株)。下呼吸道为最常见的分离部位,占70．1%(54/77株)。β内酰胺酶检测显示90%产OXA-23型碳青霉烯酶。针对35例肺部感染者,19例应用头孢哌酮-舒巴坦联合米诺环素治疗,临床总有效率68．4%,细菌清除率42．1%,显示出其对PDR-Ab仍有一定疗效。培养阳性前机械通气时间(17．5 d和5．5 d)、是否存在混合细菌感染(100%和12．5%)及GCS评分(9．1±0．7和13,2±2．1)是影响细菌清除的因素。预后分析显示感染性休克、APACHEⅡ评分是影响预后的独立危险因素,OR分别为13．8,2．1。结论PDR-Ab引起的医院感染,根据我院分离株的耐药特点,头孢哌酮-舒巴坦联合米诺环素治疗下呼吸道感染具有一定疗效。

Objective To analyze the clinical features of pandrug-resistant Acinetobacterbaumannii （PDR-Ab） in a hospital and compare the efficacy of different antibiotic treatments on patients with pneumonia caused by PDR-Ab. Methods Data were retrospectively collected from all isolated PDR-Ab strains in our hospital from February 2004 to March 2005. The clinical features and outcomes were reviewed. Results A total of 77 strains of PDR-Ab were collected, 45 of which were pathogens causing clinical infections （35 strains from lower respiratory tract, 6 from bloodstream, 3 from drainage fluid, and 1 from wounds）. Lower respiratory tract was the most common source of PDR-Ab. More than 90% of the isolated PDR-Ab strains produced OXA-23 type β-lactamase. Cefoperazone-sulbactam plus minocycline showed good efficacy for patients with PDR-Ab pneumonia. The total clinical cure rate was 68.4%. Bacterial eradication rate was 42.1%. The factors influencing bacterial clearance were prolonged mechanical ventilation prior to positive culture （17.5 d vs 5.5 d）, mixed infection （100% vs 12.5%） and lower GCS score （9.1 ± 0.7 vs 13.2 ± 2.1）. Concomitant septic shock （OR = 13.8） and APACHE Ⅱ score （OR = 2. 1 ） were independent factors of clinical outcome. Conclusions Nosocomial infections caused by PDR-Ab are not untreatable. Our analysis suggests that cefoperazone-sulbactam plus minocycline may be an effective treatment for lower respiratory tract infections caused by PDR-Ab in our hospital.