中华烧伤杂志
中華燒傷雜誌
중화소상잡지
16
2009年
5期
372-376
,共5页
张家平%杨小顺%陈建%彭毅志%黄跃生
張傢平%楊小順%陳建%彭毅誌%黃躍生
장가평%양소순%진건%팽의지%황약생
烧伤%黏菌素%多药耐药革兰阴性杆菌%疗效%不良反应
燒傷%黏菌素%多藥耐藥革蘭陰性桿菌%療效%不良反應
소상%점균소%다약내약혁란음성간균%료효%불량반응
Burns%Colistin%Multidrug-resistant gram-negative microorganisms%Therapeutic effect%Side effect
目的 评估多黏菌素E治疗严重烧伤患者多药耐药(MDR)革兰阴性杆菌感染的疗效及不良反应,为临床合理应用该抗生素提供依据.方法 选择笔者单位2005年8月-2009年1月收治的9例MDR革兰阴性杆菌感染烧伤患者,在药物敏感试验显示该感染菌种仅对多黏菌素E敏感或其他抗生素对其无效的前提下,采用多黏菌素E静脉滴注(100×10~4～150×10~4U/d)或静脉滴注联合呼吸道雾化吸入或灌洗(50×10~4～100×10~4U/d)给药.观察其细菌学疗效、临床疗效和不良反应(包括神经毒性和肾毒性,后者比较用药前后血清肌酐、尿素氮和胱抑素C水平).结果 9例患者中,7例为血流和肺部感染,1例血流、肺部和创面侵袭性感染,1例血流和尿路感染.病原菌主要为铜绿假单胞菌、鲍氏不动杆菌和嗜麦芽窄食单胞菌.9例患者应用多黏菌素E治疗后,血液中细菌清除率达92.3%;7例合并肺部感染患者,痰液MDR革兰阴性杆菌检出率从用药前的58.2%降至用药后的14.6%(P<0.01);1例合并尿路感染患者尿液中MDR革兰阴性杆菌得以清除.用药后,8例患者被判断为临床有效、1例为临床无效,有效率达88.9%.与用药前比较,9例患者用药后血清肌酐和尿素氮水平呈下降趋势;8例患者血清胱抑素C水平相近(P>0.05),1例患者明显升高但停药1个月后回降.用药期间和停药5 d内患者均未见神经毒性反应或其他不良反应.结论 在未出现更有效药物的前提下,合理应用多黏菌素E是目前治疗严重烧伤MDR革兰阴性杆菌感染的良好选择.
目的 評估多黏菌素E治療嚴重燒傷患者多藥耐藥(MDR)革蘭陰性桿菌感染的療效及不良反應,為臨床閤理應用該抗生素提供依據.方法 選擇筆者單位2005年8月-2009年1月收治的9例MDR革蘭陰性桿菌感染燒傷患者,在藥物敏感試驗顯示該感染菌種僅對多黏菌素E敏感或其他抗生素對其無效的前提下,採用多黏菌素E靜脈滴註(100×10~4～150×10~4U/d)或靜脈滴註聯閤呼吸道霧化吸入或灌洗(50×10~4～100×10~4U/d)給藥.觀察其細菌學療效、臨床療效和不良反應(包括神經毒性和腎毒性,後者比較用藥前後血清肌酐、尿素氮和胱抑素C水平).結果 9例患者中,7例為血流和肺部感染,1例血流、肺部和創麵侵襲性感染,1例血流和尿路感染.病原菌主要為銅綠假單胞菌、鮑氏不動桿菌和嗜麥芽窄食單胞菌.9例患者應用多黏菌素E治療後,血液中細菌清除率達92.3%;7例閤併肺部感染患者,痰液MDR革蘭陰性桿菌檢齣率從用藥前的58.2%降至用藥後的14.6%(P<0.01);1例閤併尿路感染患者尿液中MDR革蘭陰性桿菌得以清除.用藥後,8例患者被判斷為臨床有效、1例為臨床無效,有效率達88.9%.與用藥前比較,9例患者用藥後血清肌酐和尿素氮水平呈下降趨勢;8例患者血清胱抑素C水平相近(P>0.05),1例患者明顯升高但停藥1箇月後迴降.用藥期間和停藥5 d內患者均未見神經毒性反應或其他不良反應.結論 在未齣現更有效藥物的前提下,閤理應用多黏菌素E是目前治療嚴重燒傷MDR革蘭陰性桿菌感染的良好選擇.
목적 평고다점균소E치료엄중소상환자다약내약(MDR)혁란음성간균감염적료효급불량반응,위림상합리응용해항생소제공의거.방법 선택필자단위2005년8월-2009년1월수치적9례MDR혁란음성간균감염소상환자,재약물민감시험현시해감염균충부대다점균소E민감혹기타항생소대기무효적전제하,채용다점균소E정맥적주(100×10~4～150×10~4U/d)혹정맥적주연합호흡도무화흡입혹관세(50×10~4～100×10~4U/d)급약.관찰기세균학료효、림상료효화불량반응(포괄신경독성화신독성,후자비교용약전후혈청기항、뇨소담화광억소C수평).결과 9례환자중,7례위혈류화폐부감염,1례혈류、폐부화창면침습성감염,1례혈류화뇨로감염.병원균주요위동록가단포균、포씨불동간균화기맥아착식단포균.9례환자응용다점균소E치료후,혈액중세균청제솔체92.3%;7례합병폐부감염환자,담액MDR혁란음성간균검출솔종용약전적58.2%강지용약후적14.6%(P<0.01);1례합병뇨로감염환자뇨액중MDR혁란음성간균득이청제.용약후,8례환자피판단위림상유효、1례위림상무효,유효솔체88.9%.여용약전비교,9례환자용약후혈청기항화뇨소담수평정하강추세;8례환자혈청광억소C수평상근(P>0.05),1례환자명현승고단정약1개월후회강.용약기간화정약5 d내환자균미견신경독성반응혹기타불량반응.결론 재미출현경유효약물적전제하,합리응용다점균소E시목전치료엄중소상MDR혁란음성간균감염적량호선택.
Objective To investigate the therapeutic effect and side effects of eolistin in treating in-fections caused by multidrug-resistant (MDR) gram-negative bacillus in patients with severe burn in order to provide the basis for reasonable application of this antibiotic in clinic. Methods Nine burn patients suf-fered from infections caused by MDR gram-negative bacillus admitted to our institute from August 2005 to January 2009 were involved in this study. On the premises that isolated bacteria were only sensitive to colistin or not sensitive to other antibiotics, patients were treated with intravenous drip of colistin (100×10~4-150× 10~4U/d), or intravenous drip combined with administration of the drug into respiratory tract by atomization or instillation (50×10~4-100×10~4 U/d). The bacteriologic and therapeutic effects and side effects (inclu-ding neurotoxicity and nephrotoxicity, rise in serum levels of creatinine, urea nitrogen and cystatin C were detected and compared before and after administration) of colistin were observed. Results Out of 9 pa-tients, 7 patients were with bloodstream and pulmonary infections, 1 patient was with bloodstream, pulmona-ry, and invasive wound infections, and 1 patient was with bloodstream and urinary tract infections. The path-ogenic bacteria were proved to be Pseudomonas aeruginosa , Acinetobacter baumannii and Pseudomonas maltophilia. After the administration of colistin, bacteria clearance rate of blood reached 92.3% in 9 pa-tients;isolation rate of MDR gram-negative bacillus of sputum was significantly decreased in 7 patients with pulmonary infection (before treatment 58.2% v.s. After treatment 14.6% , P < 0.01) ;a complete MDR gram-negative bacillus clearance of urine was observed in 1 patient with urinary tract infection. Colitin was clinically effective in 8 patients but ineffective in 1 patient (effective rate 88.9%). Compared with those be-fore administration, serum levels of creatinine and urea nitrogen were decreased after administration in all pa-tients ;no significant difference in serum level of cystatin C among 8 patients was detected, except an obvious elevation in serum level of cystatin C in 1 patient after colistin therapy, and it lowered I month after discon-tinuation. No neurotoxicity or other side effect was observed during medication and 5 days after discontinua-tion in all patients. Conclusions Reasonable application of colistin is a good option for treating infections caused by MDR gram-negative bacillus in patients with severe burn, as no other more effective drug is found.
