磷霉素联合克林霉素治疗多重耐药鲍曼不动杆菌病18例临床分析

Clinical analysis of phosphonomycin combinated with clindamycin in treating hospital-acquired pneumonia due to mult-drug-resistance acinetobacter baumannii in 18 cases

目的:探讨磷霉素联合克林霉素治疗多重耐药鲍曼不动杆菌肺炎的疗效。方法:对我院ICU在2007年5月～2009年10月期间发生的医院获得性肺炎患者的临床资料、耐药性特点及药敏试验结果进行分析。结果:18例患者均对三代头孢菌素和三代氟喹诺酮类抗菌药物耐药。对亚胺培南西司他汀中介或耐药中介的12例,耐药3例。给磷霉素联合克林霉素治愈10例,好转3例,无效2例,治愈率55.5%,好转率33.3%,临床有效率(治愈+好转)88.8%。结论:ICU内医院获得性鲍曼不动杆菌肺炎发生率高,耐药性强,治疗困难;及时发现耐药合理使用抗生素有利于预防和治疗。

Objective：To investigate the prevalence,antibiotic resistance and treatment of Acinetobacter Baumannii hospital-acquired pneumonia（ABHAP）in Intensive Care Unit（ICU）in our hospital and effect of phosphonomycin combinated with clindamycin for guidance of clinical prevention and treatment of ABHAP.Methods：The clinical information and results of antibiotic susceptibility test for all of the patients with hospital-acquired pneumonia（HAP）and antibiotic resistance acinetobacter baumannii in ICU in our hospital from May 2007 to October 2009 were collected.Antibiotic resistance and effect of combination of ABHAP were analyzed retrospectively.Results：Eighteen patients were infected with acinetobacter baumannii resistant to acinetobacter baumannii.And 3 patients were resistant to imipenem and 12 patients were doubtfully resistant to imipenem.Past treatment with phosphonomycin combinated with clindamycin,10 patients were in convalescence,and 3 patients were improved.The clinic effective rate was 88.8.Conclusion：Severe drug-resistance and therapeutic difficulties of ABHAP have often happened in ICU.Shortening duration of hospitalization and invasive mechanical ventilation,rational use of antibiotics are helpful to prevent and treat ABHAP.Phosphonomycin combinated with clindamycin is effective treatment to multi-drug-resistance acinetobacter baumannii.