慢性阻塞性肺疾病急性加重抗感染治疗中国专家共识

Expert consensus on anti-infective therapy for acute exacerbation of chronic obstructive pulmonary disease in China

细菌感染是导致慢性阻塞性肺疾病急性加重(AECOPD)的重要诱因。但患者个体差异很大,为规范抗菌药物使用,国际呼吸杂志编辑部组织编写了本共识。主要推荐意见包括:(1)轻度AECOPD患者、无脓痰者暂不给予抗菌药物,但应严密观察病情变化,出现脓痰时应实施抗感染治疗。(2)应结合疾病危险分层和铜绿假单胞菌感染风险制定抗感染方案。除高度耐药地区外,单纯慢性阻塞性肺疾病患者可选用大环内酯类、第一代或第二代头孢菌素等治疗;复杂慢性阻塞性肺疾病无铜绿假单胞菌感染风险者可选用阿莫西林/克拉维酸,也可选用左氧氟沙星或莫西沙星口服或静脉治疗;有铜绿假单胞菌感染风险患者如能口服则可选用环丙沙星或左氧氟沙星,需要静脉用药时可选择抗铜绿假单胞菌的β-内酰胺类或联合左氧氟沙星;AECOPD继发医院获得性肺炎/呼吸机相关性肺炎,经验性抗感染治疗策略需依据所在医院的医院获得性肺炎/呼吸机相关性肺炎病原谱及药敏结果制定,根据后续微生物资料调整目标治疗,常需要联合用药。(3)一般感染抗感染疗程5~7 d,复杂感染(合并肺炎、支气管扩张及耐药菌感染等)适当延长至10~14 d。

Bacterial infection is crucial risk factor of acute exacerbation of chronic obstructive pulmonary disease(AECOPD).In order to optimize antibiotic therapy,the International Journal of Respiration has compiled this consensus.The recommendations are as follows.(1)Mild AECOPD patients and those without purulent sputum should not be given antibiotics temporarily,but the patients should be monitored closely.Anti-infective treatment should be carried out when purulent sputum occurs.(2)The anti-infection strategy should be made according to the risk stratifications of AECOPD and the risk of Pseudomonas aeruginosa(PA)infection.Except in areas with high drug resistance,uncomplicated AECOPD patients could be treated with drugs like macrolides,first or second generation cephalosporins.Complicated AECOPD patients without risk of PA infection could be treated with amoxicillin/clavulanic acid,levofloxacin or moxifloxacin.Patients with the risk of PA infection should be given ciprofloxacin or levofloxacin orally.If oral administration is not possible,intravenous administration ofβ-lactam antibiotics with anti-PA activity will be carried out,or levofloxacin can be used in combination.For hospital-acquired pneumonia/ventilator-associated pneumonia secondary to AECOPD,the empirical anti-infection strategy should be formulated according to the pathogen spectrum of hospital-acquired pneumonia/ventilator-associated pneumonia and the results of drug sensitivity in the hospital.The treatment should be further adjusted according to the follow-up microbiological data,and the combined use of drugs is often required.(3)In general,the course of anti-infection treatment is 5-7 days,but in complex infection cases(complicated with pneumonia,bronchiectasis,or multidrug resistant bacteria infection,etc.),it could be appropriately prolonged to 10-14 days.