婴儿肝移植术后产金属β-内酰胺酶肺炎克雷伯菌腹腔感染治疗1例及文献复习

Treatment for abdominal infection caused by metallo-β-lactamase-producing Klebsiella pneumoniae in an infant after liver transplantation:a case report and literature review

目的探讨儿童实体器官移植受者耐氨曲南的产金属β-内酰胺酶(MBL)肠杆菌科细菌感染的治疗方案。方法回顾分析1例婴儿肝移植术后耐氨曲南的产MBL肺炎克雷伯菌致腹腔感染的临床资料。患儿术后发生腹腔感染,致病菌为产MBL肺炎克雷伯菌,药敏结果提示对氨曲南耐药。初始方案基于药敏结果选用了多黏菌素B联合替加环素的方案,治疗效果不佳,同时出现病情反复和休克性花斑。临床药师协助临床医师制定头孢他啶阿维巴坦0.5 g,q8 h联合氨曲南0.18 g,q6 h的治疗方案;同时复习国内外相关文献,总结实体器官移植术后产MBL肠杆菌科细菌感染的治疗方案。结果与结论该患儿最终使用头孢他啶阿维巴坦联合氨曲南成功治愈出院。多篇国外文献报道头孢他啶阿维巴坦联合氨曲南可以有效治疗器官移植患者因耐氨曲南的产MBL肠杆菌科细菌导致的感染,该方案有望成为儿童实体器官移植受者该耐药菌感染的有效治疗方案。

OBJECTIVE To investigate the treatment plan for aztreonam-resistant metallo-β-lactamase(MBL)-producing Enterobacteriaceae infection in pediatric solid organ transplant recipients.METHODS The clinical data of aztreonam-resistant MBL-producing Klebsiella pneumoniae caused intra-abdominal infection of an infant after liver transplantation were retrospectively analyzed.Abdominal infection occurred after operation.The pathogenic bacterium was MBL-producing K.pneumoniae.The drug sensitivity results showed that the infant was resistant to aztreonam.Based on the results of sensitivity test,polymyxin B combined with tigecycline were selected as initial regimen.The treatment effect was poor,with recurrent disease and shock spots.The clinical pharmacist assisted the clinician to formulate treatment regimen of ceftazidime avibactam 0.5 g,q8 h combined with aztreonam 0.18 g,q6 h.Relevant domestic and foreign literature were reviewed,and the treatment plan of MBL-producing Enterobacteriaceae infection after solid organ transplantation was summarized.RESULTS&CONCLUSIONS The infant was finally cured and discharged with ceftazidime avibatan combined and aztreonam.Several foreign literature reported that ceftazidime avibactam combined with aztreonam could effectively treat the infection caused by aztreonam-resistant MBL-producing Enterobacteriaceae infection in patients with organ transplantation.It is expected to be an effective treatment for aztreonam-resistant MBL-producing Enterobacteriaceae infection in pediatric solid organ transplant recipients.