摘要
目的研究耐甲氧西林金葡菌(MRSA)医院获得性肺炎(HAP)中万古霉素对MRSA的最低抑菌浓度(MIC)分布、MIC值与预后的关系以及高MIC值MRSA菌株感染的危险因素。方法选择应用万古霉素治疗的MRSA HAP,采用E试验法测定MRSA菌株的MIC值,分析比较不同MIC值菌株感染患者的临床资料。结果本研究共纳入患者82例,43例(52.4%)MRSA菌株具有较高的MIC值;在基础疾病状态无明显统计学差异情况下,低MIC值和高MIC值患者万古霉素应用7 d后病原菌未清除率分别为15.4%和37.2%(P=0.026);万古霉素应用3 d后临床治疗无效率分别为25.6%和44.2%(P=0.079);28 d内肺炎复发率分别为5.7%和20.5%(P=0.129);万古霉素治疗前90 d内MRSA感染史与高MIC值MRSA感染发生明显相关(P=0.033)。结论高MIC值MRSA HAP患者万古霉素应用3 d后临床治疗无效率、7 d后病原菌未清除率及28 d内肺炎复发率高于低MIC值患者,万古霉素治疗前90 d内有MRSA感染史是HAP中高MIC值MRSA菌株感染的独立危险因素。
Objective To analyze the distribution of vancomycin minimum inhibitory concentrations (MICs) in methicillin-resist ant Staphylococcus aureus (MRSA) isolates and the efficacy of vancomycin relative to vaneomycin MICs in patients with hospi- tal acquired MRSA pneumonia, and identify the risk factors of high vancomycin MICs. Methods This study involved hospital acquired MRSA pneumonia treated with vancomycin. Vancomycin MICs were determined using E-test. The patients were as signed to high vancomycin MIC group (MIC 〉1 mg/L) or low vancomycin MIC group (MIC≤1 mg/L). The clinical charac- teristics of these two patient groups were compared. Results Eighty-two patients were included in this study. Forty-three (52.4%) isolates showed high vancomycin MICs. There was no significant difference between the two patients groups in terms of baseline characteristics. Mierobiologic failure rate after 7 days of vancomycin treatment was 15.4% and 37.2% in the low- and high MIC groups, respectively (P = 0. 026). Clinical failure after 3 days of treatment (25.6% versus 44.2%, P = 0. 079) and relapse rate of MRSA pneumonia within 28 days (5.7Y0 versus 20. 5%, P = 0. 129) was significantly higher in the high MIC group than in the low MIC group. Prior MRSA in fection within 90 days of vancomycin treatment (P = 0. 033) was significantly associated with high vancomycin MIC val- ue. Conclusions Hospital acquired pneumonia caused by MRSA with high vancomycin MIC show a higher clinical failure after 3 days of vancomycin treatment, microbiologic failure and re- lapse of MRSA pneumonia within 28 days compared with those caused by MRSA with low vancomycin MIC. Patients with a history of MRSA infection within 90 days before vancomycin treatment should be considered as an independent risk factor of hospital-acquired pneumonia caused by MRSA strains with high vancomycin MIC.
出处
《中国感染与化疗杂志》
CAS
北大核心
2013年第5期388-392,共5页
Chinese Journal of Infection and Chemotherapy
基金
中华医学会临床医学科研专项资金项目(10030160238)
关键词
万古霉素
最低抑菌浓度
耐甲氧西林金黄色葡萄球菌
医院获得性肺炎
vancomycin
minimum inhibitory concentration
methicillin-resistant Staphylococcus aureusi hospital-acquiredpneumonia