一例重症胰腺炎伴多药耐药肺炎克雷伯菌脓毒血症治疗成功的抗感染策略分析

The therapeutic strategy in the successful treatment of a patient with severe pancreatitis combined with multiple drug resistant Klebsiella pneumoniae sepsis

目的:讨论一例重症胰腺炎伴发多药耐药(MDR)肺炎克雷伯菌(Kpn)脓毒血症治疗成功的抗感染策略,为MDR-Kpn的治疗积累经验。方法:记录病人的临床表现,结合各项实验室检验指标及抗感染治疗药物种类、疗程及联用方案,分析抗菌药物治疗策略。结果:该例病人住院期间依次使用了替加环素+亚胺培南/西司他汀钠、替加环素+亚胺培南/西司他汀钠+阿米卡星、替加环素+头孢哌酮钠/舒巴坦钠、头孢哌酮钠/舒巴坦钠+阿米卡星、头孢哌酮钠/舒巴坦钠+磷霉素的多药联合治疗方案。入院第52天血培养转阴并保持,各项细菌感染炎性指标转为正常,病情好转稳定,MDR-Kpn脓毒血症治愈。结论:MDR-Kpn在缺乏明确有效的抗菌药物时,及时联合应用治疗Kpn的一线和二线药物,延长疗程是治疗成功的关键。

Objective： To discuss the anti-infection strategy for the successful treatment of a case of severe pancreatitis combined with multiple drug resistant Klebsiella pneumoniae （MDR-Kpn） sepsis and to accumulate clinical experience for the treatment of MDR-Kpn. Methods：Anti-bacterial drug treatment strategy was analyzed through recording of clinical manifesta- tions associated with various biochemical indicators and categories of anti-infectious drugs, treatment courses and drug combina- tion profiles. Results：During hospitalization, the patient was treated in sequence with various combinations of antibiotics, inclu- ding tigecycline plus imipenem/eilastatin sodium, tigeeyeline plus imipenem/cilastatin sodium plus amikacin, tigecycline plus eef operazone sodium/sulbaetam sodium, cefoperazone sodium/sulbactam sodium plus amikaein,and eefoperazone sodium/sulbactam sodium plus fosfomycin. Fifty-two days after admission into the hospital, blood culture turned negative and was stably main- tained. All the inflammatory markers returned to normal. The patient＇s conditions became stable, and finally this rare case of MDR-Kpn sepsis was cured successfully. Conclusion： Without definitively effective anti-bacterials, in-time combined therapy with first-line and second-line drugs and with extended treatment courses was the key to the successful treatment of MDR-Kpn sepsis.