慢性阻塞性肺疾病急性加重期患者的抗感染治疗

Anti-infective Treatment of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的:探讨慢性阻塞性肺疾病急性加重(AECOPD)期患者初始抗感染药的选用、联用、更换以及用法用量的合理性,为该类患者抗感染药的合理应用提供参考。方法:从AECOPD患者肺部感染的常见致病菌及耐甲氧西林金黄色葡萄球菌(MRSA)感染的高危因素分析初始抗感染治疗方案,结合微生物培养和药敏试验结果对抗感染药的更换作出评价。结果:患者初始抗感染药联用莫西沙星、氟康唑和替考拉宁基本合理,后续改为头孢哌酮/舒巴坦、伊曲康唑和替考拉宁三者联用基本合理,但替考拉宁一直使用负荷剂量,给药剂量过大,q8h给药频次过高。结论:给药方案应充分结合药物的药动学特征和患者个体情况而制订;同时需了解AECOPD患者感染的常见致病菌及耐药情况以提高经验性用药的准确性。

OBJECTIVE：To evaluate the rationality in the selection,combination,replacement and usage of the initial anti-infective drugs for patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） so as to provide reference for rational use of anti-infective drugs for patients with AECOPD.METHODS：The initial anti-infective treatment program for AECOPD patients was analyzed in respect of common pathogens of pulmonary infection and the risk factors for methicillin resistant S.aureus （MRSA） infection.The replacement of anti-infective drugs was evaluated based on microbial culture and drug sensitivity test results.RESULTS：The combination of moxifloxacin,fluconazole and teicoplanin during initial anti-infective treatment followed by combination of cefoperazone sulbactam,traconazole and teicoplanin were rational on the whole; however,the use of teicoplanin remained at a loading dose characterized by excessively large dose and high administration frequency （q8h）.CONCLUSIONS：Pharmacokinetic characteristics and individual status must be taken into consideration in making dose schedule; meanwhile,it is necessary to familiarize the common pathogens and drug resistance in AECOPD patients in order to improve the accuracy of empiric treatment.