噬菌体治疗泛耐药肺炎克雷伯菌肺部感染的临床应用及效果初探

Clinical application and effect of phage on the treatment of pulmonary infection by pan-drug resistant Klebsiella pneumoniae

目的·探讨使用噬菌体雾化吸入治疗泛耐药肺炎克雷伯菌肺部感染的用药频率及效果。方法·在治疗开始前1 h和使用噬菌体雾化吸入治疗肺部感染过程中每小时,取患者痰液样本进行细菌分离纯化及质谱鉴定,比较细菌裂解谱的异同;同时,于治疗开始前1 h,第一次治疗开始后2、4 h取血液样本进行细菌培养及噬菌体量的测定。结果·噬菌体经雾化吸入后2 h在体内持续增殖,3 h后噬菌体量下降,4 h后进行第二次治疗,噬菌体在体内的增殖规律与第一次相同;第三次使用噬菌体治疗时,噬菌体仅有少量增殖。噬菌体治疗后患者痰液中仍分离到肺炎克雷伯菌,但分离株的噬菌体裂解谱发生了变化,患者临床症状改善。结论·噬菌体能够有效针对靶细菌进行杀灭并改善患者的临床症状。泛耐药肺炎克雷伯菌肺部感染患者经2次雾化吸入治疗即可达到噬菌体使用的最佳效果。噬菌体治疗后病原菌菌株发生了变化。

Objective·To explore the therapeutic frequency and effect of phage treatment on pan-drug resistant Klebsiella pneumoniae by aerosolized phage.Methods·The patient's sputum was taken 1 h before the start of treatment and every hour during the treatment of pulmonary infection using nebulized inhaled phage.The sputum samples were subjected to bacterial isolation,purification and mass spectrometry identification.The lytic spectrum of different bacterial isolations was compared.And blood samples for bacteria were taken 1 h before the start of the treatment and 2 h and 4 h after the first treatment for bacterial culture and phage volume determination.Results·The phage continued to proliferate in vivo for 2 h,and decreased after 3 h.When the second phage treatment was performed after 4 h,the pattern of phage proliferation in vivo was the same as the first time.During the third treatment,the phage was proliferated slightly in vivo.After phage treatment,Klebsiella pneumoniae was still isolated in the patient's sputum.However,the phage cleavage spectrum of the isolations was different,and the patient's clinical symptoms improved.Conclusion·Phages can effectively target infectious bacteria and kill them.The clinical symptoms of patient improve.Twice aerosolized phage treatment for the patient with pulmonary infection is enough to achieve the best effect.The isolated bacterial strain is different post phage treatment.