两例疑似泛耐药鲍曼不动杆菌感染的临床处置和转归分析

Clinical management and results analysis of two cases of suspected extensive drug resistant Acinetobacter baumannii infection

目的:探讨临床分离的泛耐药鲍曼不动杆菌(extensive drug-resistant Acinetobacter baumannii,EDRAB)的两种处置方法:积极的治疗或者在病情允许的情况下停用抗菌药物的观察性治疗,对临床转归的影响。方法:回顾分析发生在三甲和二甲医院的两例疑似EDRAB感染病例,讨论所进行的积极治疗和谨慎的停药观察治疗结果。结果:根据临床多次微生物培养(痰标本、导尿管标本和脑脊液标本)和药敏试验结果,确定的积极治疗方案效果不佳,而所谓有效的治疗药物又是药敏试验提示为耐药的抗菌药物。其中1例病人在H医院抗感染治疗时,临床谨慎停用抗菌药物而采取观察性治疗,获得了良好的效果。结论:如果基于药敏试验结果而调整的抗感染治疗无效,同时病人的"感染中毒症状"轻微,要考虑可能混合了其他病原菌的感染,而针对EDRAB的治疗,则可以尝试"停药观察性治疗"。

Objective：To investigate the effects of 2different management methods（active treatment and observation treatment without the application of anti-extensive drug resistant A.baumannii（EDRAB）antimicrobials）on clinically isolated EDRAB and on the prognosis of the disease,when the patients＇ conditions permitted.Methods：Two suspected cases of EDRAB infection that occurred in the third and second class tertiary hospitals were analyzed retrospectively,and the results of active treatment and careful observation treatment with drug withdrawal were discussed in the paper.Results：In accordance with the results of microbiological cultures（sputum,catheter specimen and cerebrospinal fluid samples）and drug sensitivity tests,it was proved that active treatment protocol failed to achieve ideal results,and EDRAB was resistant to the so-called effective drugs.One of the patients who received anti-bacterial treatment in the H hospital was transferred to observation treatment with careful withdrawal of antibiotics and achieved good therapeutic results.Conclusion：If anti-infective therapy based on drug sensitivity tests proved to be ineffective and only mild ＂infection symptoms＂ were shown,the possibility of other pathogenic infection should be considered.Then,for the treatment of EDRAB infection,observation treatment with the withdrawal of antibacterials could be tried.