基于菌群拮抗作用的抗感染方案治疗多重耐药肺炎克雷伯菌肺部感染的效果

Effect of anti-infection regimen based on bacterial antagonism in treatment of multidrug-resistant Klebsiella pneumoniae pulmonary infection

目的 探讨借助菌群拮抗作用实施抗感染治疗对于重耐药肺炎克雷伯菌(MDR-Kpn)肺部感染的疗效。方法 从上海市杨浦区中心医院2019年至2021年期间住院患者中选择MDR-Kpn肺部感染患者80例,均使用常规抗生素治疗效果不理想,痰培养结果提示MDR-Kpn生长,调整为基于菌群拮抗作用的新治疗方案:先给予头孢美唑抗感染治疗48~72 h,痰培养结果提示铜绿假单胞菌生长,再按照患者病情改用对铜绿假单胞菌有效的抗生素,比较常规治疗前、调整治疗方案前、新方案治疗后7dC反应蛋白(CRP)、降钙素原(PCT)及临床肺部感染评分(CPIS)。结果 常规治疗前CRP(93.28±21.84)mg/L、PCT(2.17±0.54)ng/mL与调整治疗方案前CRP(91.47±19.72)mg/L、PCT(2.22±0.38)ng/mL无明显差异(P>0.05);应用新治疗方案后7 d患者CRP(56.82±13.35)mg/L、CPT(1.18±0.32)ng/mL明显降低(P<0.05);所有患者经常规治疗后CPIS评分(7.16±1.34)、SOFA评分(9.53±2.87)、APACHEⅡ评分(19.63±4.73)均与治疗前(7.32±1.47、9.72±3.21、20.17±3.35)无明显差异(P>0.05);采用新方案治疗7 d后,CPIS(5.87±1.12)、SOFA(7.84±2.28)、APACHEⅡ评分(16.27±2.82)明显降低(P<0.05);80例患者住ICU时间为13~21 d,平均(16.86±3.28)d,均顺利转出ICU。结论 借助菌群之间的拮抗作用,诱导非MDRO的生长,对MDRO形成有效抑制,为临床选择药物提供更多的机会,从而用效控制感染,提高治疗效果。

Objective To investigate the effect of anti-infection therapy with bacterial antagonism in the treatment of multidrug-resistant Klebsiella pneumoniae(MDR-Kpn) pulmonary infection.Methods Totally 80 patients with MDR-Kpn pulmonary infection were selected from the inpatients in our hospital from 2019 to 2021,and the effect of conventional antibiotic treatment was not ideal.Sputum culture results suggested the growth of MDR-Kpn, which was adjusted to a new treatment plan based on bacterial flora antagonism: Cefmetazole was given anti-infection treatment for 48~72 hours, sputum culture results indicated pseudomonas aeruginosa growth, and then according to the patient’s condition to use effective antibiotics for Pseudomonas aeruginosa.The 7 dC reactive protein(CRP),procalcitonin(PCT) and clinical pulmonary infection score(CPIS) were compared before conventional treatment, before adjusting treatment plan, after new treatment.Results There were no significant differences in CRP(93.28±21.84)mg/L and PCT(2.17±0.54)ng/mL before conventional treatment(91.47±19.72)mg/L and PCT(2.22±0.38)ng/mL after conventional treatment(P>0.05).CRP(56.82±13.35)mg/L and CPT(1.18±0.32)ng/mL were significantly decreased 7 days after the application of the new treatment regimen(P<0.05).After conventional treatment, CPIS score(7.16±1.34),SOFA score(9.53±2.87),APACHE Ⅱ score(19.63±4.73) had no significant difference from that before treatment(7.32±1.47,9.72±3.21,20.17±3.35)(P>0.05).CPIS(5.87±1.12),SOFA(7.84±2.28) and APACHE Ⅱ score(16.27±2.82) were significantly decreased after 7 days of treatment with the new regimen(P<0.05);80 patients stayed in ICU for 13-21 days, with an average of(16.86±3.28) days, and were successfully transferred out of ICU.Conclusion The antagonism between bacteria can induce the growth of non-MDRO,effectively inhibit THE formation of MDRO,provide more opportunities for clinical selection of drugs, so as to control infection with effect and improve the therapeutic effect.