临床医学
臨床醫學
림상의학
CLINICAL MEDICINE
2009年
5期
1-3
,共3页
陈裕胜%黄昭%程园园%林材元
陳裕勝%黃昭%程園園%林材元
진유성%황소%정완완%림재원
洋葱伯克霍尔德菌%医院肺部感染%重症监护病房%耐药性
洋蔥伯剋霍爾德菌%醫院肺部感染%重癥鑑護病房%耐藥性
양총백극곽이덕균%의원폐부감염%중증감호병방%내약성
Burkholderia cepacia%Nosocomial pulmonary infection%Intensive care unit%Antimicrobial resistance
目的 探讨重症监护病房(ICU)洋葱伯克霍尔德菌肺部感染的临床特点及病原菌耐药情况及其防治措施.方法 对2005年1月至2008年11月在ICU住院期间,28例洋葱伯克霍尔德菌院内肺部感染病例进行回顾性分析.结果 本组病例多发生于老年人,有多种原发病或伴随疾病;感染患者往往病情突然加重,痰量明显增多,肺部渗出短期内明显增加;19种抗菌药物药敏试验结果显示复方磺胺甲基异噁唑、美罗培南、哌拉西林/他唑巴坦、头孢吡肟和头孢他啶的体外活性较高,在85%以上;其次为哌拉西林,敏感率为71.4%,头孢曲松、左氧沙星敏感率在50%～60%之间,环丙沙星敏感率为36%,其余均<30%.结论 洋葱伯克霍尔德菌具有多重耐药性,治疗难度大,应引起足够重视,需根据药敏试验结果选用敏感药物,如美罗培南、复方磺胺甲基异噁唑、哌拉西林/他唑巴坦、头孢他啶和头孢吡肟等.
目的 探討重癥鑑護病房(ICU)洋蔥伯剋霍爾德菌肺部感染的臨床特點及病原菌耐藥情況及其防治措施.方法 對2005年1月至2008年11月在ICU住院期間,28例洋蔥伯剋霍爾德菌院內肺部感染病例進行迴顧性分析.結果 本組病例多髮生于老年人,有多種原髮病或伴隨疾病;感染患者往往病情突然加重,痰量明顯增多,肺部滲齣短期內明顯增加;19種抗菌藥物藥敏試驗結果顯示複方磺胺甲基異噁唑、美囉培南、哌拉西林/他唑巴坦、頭孢吡肟和頭孢他啶的體外活性較高,在85%以上;其次為哌拉西林,敏感率為71.4%,頭孢麯鬆、左氧沙星敏感率在50%～60%之間,環丙沙星敏感率為36%,其餘均<30%.結論 洋蔥伯剋霍爾德菌具有多重耐藥性,治療難度大,應引起足夠重視,需根據藥敏試驗結果選用敏感藥物,如美囉培南、複方磺胺甲基異噁唑、哌拉西林/他唑巴坦、頭孢他啶和頭孢吡肟等.
목적 탐토중증감호병방(ICU)양총백극곽이덕균폐부감염적림상특점급병원균내약정황급기방치조시.방법 대2005년1월지2008년11월재ICU주원기간,28례양총백극곽이덕균원내폐부감염병례진행회고성분석.결과 본조병례다발생우노년인,유다충원발병혹반수질병;감염환자왕왕병정돌연가중,담량명현증다,폐부삼출단기내명현증가;19충항균약물약민시험결과현시복방광알갑기이오서、미라배남、고랍서림/타서파탄、두포필우화두포타정적체외활성교고,재85%이상;기차위고랍서림,민감솔위71.4%,두포곡송、좌양사성민감솔재50%～60%지간,배병사성민감솔위36%,기여균<30%.결론 양총백극곽이덕균구유다중내약성,치료난도대,응인기족구중시,수근거약민시험결과선용민감약물,여미라배남、복방광알갑기이오서、고랍서림/타서파탄、두포타정화두포필우등.
Objective To evaluate the clinical characteristics and bacterial resistance of pulomonary infections caused by Burkholderia cepaciain in intensive care unit and discuss how to control such infections. Methods The clinical data of 28 cases discharged from January. 2005 to November. 2008 were reviewed. Results Such nosocomial pulmonary infection caused by Burkholderia cepacia were commonly seen in older patients. Patients usually had some underlying diseases. Infectious patients generally presented as suddenly progressive condition, companied with increased sputum production and radiographic pulmonary infiltrate in a short period. Among the 19 antimicrobial agents tested, TMP-SMZ, meropenem, piperacillin-tazobactam, cefepime and ceftazidime were the most active. The susceptibility rates of piperacillin were 71.4%. However, Burkholderia cepacia isolates were resistant to other agents tested. Conclusion Susceptibility of Burkholderia cepacia antimicrobial agents indicated that attention should be paid to multidrug resistance in ICU. Rational use of antibiotics are very important in managing pulmonary infections caused by Burkholderia cepacia. Meropenem, TMP-SMZ,piperacillin-tazobactam, ceftazidime and cefepime are of choice for the treatment of Burkholderia cepacia infections.
