不同用药方案治疗黏液型铜绿假单胞菌的临床效果

Clinical analysis on different prescriptions for mucoid Pseudomonas aeruginosa

目的探讨黏液型铜绿假单胞菌单一用药与联合用药的临床治疗效果。方法将2011年6月至2017年12月秦皇岛市第二医院就诊的108例黏液型铜绿假单胞菌感染者分为亚胺培南组(26例),亚胺培南联合阿奇霉素组(56例)和克林霉素联合左氧氟沙星组(28例)。采用API鉴定卡及K-B纸片扩散法对菌株进行鉴定及药敏试验,采用平板菌落计数法统计治疗2、4、8 d的菌落数,统计患者治疗后1周、2周的复检阳性率。结果黏液型铜绿假单胞菌对7种药物敏感率超过70%。亚胺培南组治疗2、4、8 d痰样本中黏液型铜绿假单胞菌菌落数分别为(7.76±0.91)×10^4、(7.24±0.99)×10^4和(6.54±1.06)×10^4 g.cfu/mL,明显高于亚胺培南联合阿奇霉素组(t=12.78、18.06、19.16,P<0.05)、克林霉素联合左氧氟沙星组(t=12.40、23.83、14.65,P<0.05)。亚胺培南组1周、2周后复检阳性率为83.33%和75.00%,明显高于亚胺培南联合阿奇霉素组的48.21%和21.43%(χ^2=11.01、8.19,P<0.05)和克林霉素联合左氧氟沙星组的50.00%和17.86%(χ^2=20.57、17.11,P<0.05)。结论黏液型铜绿假单胞菌使用体外药敏试验敏感药物与能抑制细菌表面生物膜作用的药物联合应用,治疗效果较单一用药明显。

Objective To investigate the clinical effect of single drug and combined drug therapy for mucus-type Pseudomonas aeruginosa (P. aeruginosa). Methods A total of 108 cases with mucoid P. aeruginosa infection in the Second Hospital of Qinhuangdao from June 2011 to December 2017 were divided into imipenem group (n=26), imipenem combined with azithromycin group (n=56) and clindamycin combined with levofloxacin group (n=28). Strains isolated from patients were identified by API strip. Antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method. Plate colony counting method was used to count the number of colonies at 2, 4 and 8 days of treatment, and the positive rates of re-examination at 1 and 2 weeks after treatment were analyzed. Results Mucoid P. aeruginosa was sensitive to 7 antibiotics with the sensitivity of over 70%. The bacterial colonies of mucoid P. aeruginosa treated with imipenem alone for 2, 4 and 8 days were (7.76±0.91)×10^4,(7.24±0.09)×10^4 and (6.54±1.06)×10^4g.cfu/mL, respectively, which were significantly more than those treated with imipenem combined with azithromycin (t=12.78, 18.06, 19.16, P<0.05) and clindamycin combined with levofloxacin (t=12.40, 23.83, 14.65, P<0.05). The positive rates of re-examination in imipenem group were 83.33% and 75.00% at 1 and 2 weeks after treatment, which were significantly higher than those in imipenem combined with azithromycin group of 48.21% and 21.43%(χ^2=11.01, 8.19, P<0.05), clindamycin combined with levofloxacin group of 50.00% and 17.86%(χ^2=20.57, 17.11, P<0.05). Conclusions Sensitive drugs combined with drugs which can inhibit bacterial surface biofilm effect have more obvious clinical effect on mucoid P. aeruginosa than sigle drug.