多黏菌素治疗人禽流感继发铜绿假单胞菌感染一例

The treatment of multidrug-resistant Pseudomonas aeruginosa with polymyxin B or E in a patient with the highly pathogenic avian influenza A(H_5N_1) infection:a case report and review of the literature

目的探讨人感染高致病性禽流感继发多耐药铜绿假单胞菌(MDRP)肺部感染的治疗方法。方法2006年6月,对1例高致病性H5N1亚型禽流感并急性呼吸窘迫综合征(ARDS)青年男性患者进行机械通气治疗,随后出现MDRP的肺部感染;病原学药敏结果显示,该株MDRP仅对多黏菌素B和E等少量抗菌药物敏感;遂予以多黏菌素B每日40～100mg分2次肌肉或静脉注射,并多黏菌素E每日30～50万u分3～4次雾化吸入,使用剂量根据痰菌半定量检测结果进行调整。结果多黏菌素B全身用药累积疗程33d,累积剂量1760mg;多黏菌素E雾化吸入累积疗程36d,累积剂量1485万u;患者肺部感染得到有效控制;多黏菌素治疗MDRP有效且不良反应较轻,其治疗终点的判断需根据临床和实验室资料进行全面评估。结论多黏菌素能有效治疗禽流感患者继发MDRP的感染。

Objective To study the treatment of the multidrug-resistant Pseudomonas aeruginosa （MDRP） pulmonary infection in patient with the highly pathogenic avian influenza A（H5N1）infection. Methods In June 2006, a 31-year old male with avian influenza A （H5N1） infection complicated with acute respiratory distress syndrome （ARDS） was mechanically ventilated, and then MDRP pulmonary infection was confirmed. The antimicrobial susceptibility tests indicated that the infected MDRP strain in the case was sensitive only to polymyxin B or E. Polymyxin B was subsequently administered intramuscularly or intravenously at a dosage of 40-100mg/day in two divided doses and combined with polymyxin E aerosol therapy with a dosage of 30-50 million IU per day in 3-4 divided doses. The dosage adjustments were done mainly according to the semi-quantitative MDRP analysis, and the overall evaluation of the clinical and laboratory data was considered to decide the course of MDRP antibiotic therapy. Results The cumulative duration of polymyxin B systemic administration was 33 days and its cumulative dosage was 1,760 mg while that of polymyxin E aerosol administration was 36 days and its cumulative dosage was 1485 million IU. The pulmonary infection in the patient was well controlled with the improvement of clinical outcomes. Counts of Pseudonomas aeruginosa （＋＋＋＋） found in sputum culture were reduced siynificantly （＋）. Polymyxin was effective in the treatment of MDRP pulmonary infections and had slight side effects. Conclusions Polymyxin was effective in the management of MDRP pulmonary infections in patient with avian influenza.