多重耐药肺炎克雷伯菌肺部感染的抗感染治疗新策略

A new strategy for anti-infection treatment of multi-drug resistant Klebsiella pneumoniae infection

目的尝试使用新的抗感染治疗策略治疗多重耐药肺炎克雷伯菌肺部感染。方法选择10例转入ICU的院内获得性肺部感染患者,入选患者使用抗生素治疗效果不佳,多次痰培养结果提示多重耐药的肺炎克雷伯菌生长。患者先予以头孢美唑抗感染治疗,在48～72h后痰培养结果均提示对亚胺培南等敏感的铜绿假单胞菌生长,然后根据患者肺部感染是否好转选择继续使用头孢美唑或调整为对铜绿假单胞菌有效的抗生素。结果 10例患者治疗7d后C反应蛋白(CRP)、降钙素原(PCT)、临床肺部感染评分(CPIS)均显著下降(P<0.05),所有患者均顺利脱机拔管转出ICU。结论根据肺部微生态特点,利用菌群之间存在的拮抗作用,可以使用抗生素来调节微生态失衡。对于合适的患者,这种新的抗感染策略可以有效治疗多重耐药肺炎克雷伯菌肺部感染,可作为临床抗感染策略之一。

Objective To treat the multi-drug resistant Klebsiella pneumoniae infections with a new anti-infection treatment strategy.Methods 10 cases of nosocomial acquired pulmonary infections in ICU were collected.All patients were treated poorly with antibiotics and the sputum culture results suggested extensive Klebsiella pneumoniae growth.Patients were firstly treated with cefmetazole for anti-infective therapy.After 48-72 h,sputum culture results suggested that the drug sensitive Pseudomonas aeruginosa grew.Then,according to whether the patient′s lung infection improved,patients can chose to continue using cefmetazole or adjust to other effective antibiotic against Pseudomonas aeruginosa.Results After 7 days treatment,C reactive protein（CRP）,procalcitonin（PCT）,and the clinical pulmonary infection score（CPIS）were significantly decreased in 10 patients（P〈0.05）.All patients were successfully removed from the catheter and transferred to the ICU.Conclusion Based on the characteristics of the lung microecology and antagonistic effects between the flora,we can use antibiotics to adjust the imbalance of the microecology.To appropriate patients,the new anti-infection strategy can effectively treat multi-drug resistant Klebsiella pneumoniae lung infection and can be a strategy for clinical anti-infection.