鲍曼不动杆菌肺炎的耐药机制及中西医治疗研究进展

A review on the drug resistance mechanism and treatment of Acinetobacter baumannii pneumonia

鲍曼不动杆菌是重症监护室(Intensive Care Unit,ICU)常见的革兰氏阴性菌,近几年由于各种危险因素及抗生素滥用,使得ICU患者感染鲍曼不动杆菌的概率、耐药性在不断增加,临床上普通抗生素对于鲍曼不动杆菌的疗效欠佳,给鲍曼不动杆菌的防治带来重重困难。鲍曼不动杆菌作为机会致病菌,其危险因素是相关肺炎发生的重要条件,深静脉置管增加了导管感染的风险,附着在导管上的鲍曼不动杆菌通过血管导管更易引起全身的感染,也成为患者病死率增加的重要原因。插管患者口腔存在的念珠菌通过管道定植于气道内,增加了鲍曼不动杆菌发生的风险,鲍曼不动杆菌在肺部长期定植,逐渐耐药,最终发展为耐药鲍曼不动杆菌肺炎。在中医学中,鲍曼不动杆菌肺炎根据其症状特点归属于“咳嗽”“喘证”的范畴,其发生发展与正气亏虚有着密切的联系,作为条件致病菌的鲍曼不动杆菌,其符合“伏邪”的机制,根据患者临床上的不同表现予中医辨证施治,医家通过祛邪扶正的方式取得了较好的临床疗效。基于此,文章对近5年来鲍曼不动杆菌的理论研究、临床研究、作用机制研究的相关文献进行综述和讨论,为更深入地寻找治疗耐药鲍曼不动杆菌的方法提供参考与启示。现将近几年对鲍曼不动杆菌的耐药机制及中西医治疗的进展综述如下。

Acinetobacter baumannii is a common gram-negative bacterium in ICU.In recent years,due to various risk factors and antibiotic abuse,the incidence and drug resistance of Acinetobacter baumannii infection in ICU patients have been increasing.The clinical efficacy of common antibiotics for Acinetobacter baumannii is poor,which brings many difficulties to the prevention and treatment of Acinetobacter baumannii.Acinetobacter baumannii is an opportunistic pathogen,and its risk factors are important conditions for the occurrence of associated pneumonia.Deep vein catheterization increases the risk of catheter infection,and Acinetobacter baumannii attached to the catheter is more likely to cause systemic infection through vascular catheter-related infection,which also becomes an important reason for the increased mortality of patients.Candida in the oral cavity of intubated patients colonizes the airway through the tube,increasing the risk of Acinetobacter baumannii.Acinetobacter baumannii colonizes the lungs for a long time,gradually becoming resistant to drugs,and eventually developing drug-resistant acinetobacter baumannii pneumonia.In traditional Chinese medicine,Acinetobacter baumannii pneumonia belongs to the category of cough and asthmatism according to its symptom characteristics.Its occurrence and development are closely related to deficiency of healthy Qi(气).Acinetobacter Baumannii,as an opportunistic pathogen,is in line with the mechanism of“hidden evil”and is treated differentially in traditional Chinese medicine according to different clinical manifestations of patients,which achieves a good clinical effect.Based on this,this paper reviews and discusses the related literature of theoretical research,clinical research and mechanism of action of Acinetobacter baumannii in recent 5 years,with a prospect of providing reference and enlightenment for further searching for treatment of drug-resistant Acinetobacter baumannii.The mechanism of drug resistance of Acinetobacter baumannii and the progress of TCM and Western medicine treatment in recent years are summarized as follows.