西北药学杂志
西北藥學雜誌
서북약학잡지
Northwest Pharmaceutical Journal
2015年
5期
615-617,618
,共4页
耐甲氧西林金黄色葡萄球菌%医院获得性肺炎%临床肺部感染评分(C PIS评分)
耐甲氧西林金黃色葡萄毬菌%醫院穫得性肺炎%臨床肺部感染評分(C PIS評分)
내갑양서림금황색포도구균%의원획득성폐염%림상폐부감염평분(C PIS평분)
cmethicillin-resistant Staphylococcus aureus%hospital-acquired pneumonia%CPIS
目的：评估由耐甲氧西林金黄色葡萄球菌引起的医院相关肺炎（MRSA‐HAP）的诊断和治疗中存在的问题。方法对该院的83例患有MRSA‐HAP的病历进行分析，同时收集62例在此期间从其呼吸道样品发现MRSA、已经恢复而未治疗其肺炎的患者为对照组。通过病例回顾性调查资料，计算临床肺部感染评分（CPIS评分）。计算第1天和第3天CPIS评分。在治疗组中，对使用的每种抗生素的血清浓度进行测定。结果第1天和第3天的C PIS评分在2组中显示出相似的趋势，治疗组为2．5±1．8和3．9±1．9，对照组为2．9±1．9和3．8±1．6。治疗组4例（5％）患者CPIS评分在第1天超过6，治疗组10例患者（12％）利用适当的目标治疗血清浓度下的抗菌剂进行治疗。在应用了急性生理学和慢性健康评估II（APACHE II）评分来匹配患者的基线死亡率后，治疗组30 d死亡率仍然显著高于对照组。结论本研究揭示了呼吸科用药常见问题，M RSA呼吸道定植经常被看作是肺炎，并且使用的抗菌剂的剂量不足。对由MRSA感染引起的HAP的鉴别诊断和治疗需要谨慎对待。
目的：評估由耐甲氧西林金黃色葡萄毬菌引起的醫院相關肺炎（MRSA‐HAP）的診斷和治療中存在的問題。方法對該院的83例患有MRSA‐HAP的病歷進行分析，同時收集62例在此期間從其呼吸道樣品髮現MRSA、已經恢複而未治療其肺炎的患者為對照組。通過病例迴顧性調查資料，計算臨床肺部感染評分（CPIS評分）。計算第1天和第3天CPIS評分。在治療組中，對使用的每種抗生素的血清濃度進行測定。結果第1天和第3天的C PIS評分在2組中顯示齣相似的趨勢，治療組為2．5±1．8和3．9±1．9，對照組為2．9±1．9和3．8±1．6。治療組4例（5％）患者CPIS評分在第1天超過6，治療組10例患者（12％）利用適噹的目標治療血清濃度下的抗菌劑進行治療。在應用瞭急性生理學和慢性健康評估II（APACHE II）評分來匹配患者的基線死亡率後，治療組30 d死亡率仍然顯著高于對照組。結論本研究揭示瞭呼吸科用藥常見問題，M RSA呼吸道定植經常被看作是肺炎，併且使用的抗菌劑的劑量不足。對由MRSA感染引起的HAP的鑒彆診斷和治療需要謹慎對待。
목적：평고유내갑양서림금황색포도구균인기적의원상관폐염（MRSA‐HAP）적진단화치료중존재적문제。방법대해원적83례환유MRSA‐HAP적병력진행분석，동시수집62례재차기간종기호흡도양품발현MRSA、이경회복이미치료기폐염적환자위대조조。통과병례회고성조사자료，계산림상폐부감염평분（CPIS평분）。계산제1천화제3천CPIS평분。재치료조중，대사용적매충항생소적혈청농도진행측정。결과제1천화제3천적C PIS평분재2조중현시출상사적추세，치료조위2．5±1．8화3．9±1．9，대조조위2．9±1．9화3．8±1．6。치료조4례（5％）환자CPIS평분재제1천초과6，치료조10례환자（12％）이용괄당적목표치료혈청농도하적항균제진행치료。재응용료급성생이학화만성건강평고II（APACHE II）평분래필배환자적기선사망솔후，치료조30 d사망솔잉연현저고우대조조。결론본연구게시료호흡과용약상견문제，M RSA호흡도정식경상피간작시폐염，병차사용적항균제적제량불족。대유MRSA감염인기적HAP적감별진단화치료수요근신대대。
Objective We aimed to evaluate the clinical problems in the diagnosis and treatment of hospital‐associated pneumonia due to methicillin‐resistant Staphylococcus aureus (MRSA‐HAP) .Methods 83 patients ,diagnosed with MRSA‐HAP by a primary physician ,who had received antimicrobial therapy ,were enrolled in the study .62 of recovered MRSA patients who were not trea‐ted for pneumonia ,were chosen as untreated controls .Clinical pulmonary infection scores (CPIS) were calculated on day 1 and day 3 .In the treated group ,serum concentrations of each therapeutic drug used were also evaluated .Results The day 1 and day 3 CPIS showed a similar trend in the two groups ,2 .5 ± 1 .8 and 3 .9 ± 1 .9 for the treated group ,and 2 .9 ± 1 .9 and 3 .8 ± 1 .6 for the control group .Only 4 patients(5% ) in the treated group showed a CPIS of more than 6 on day 1 .Only 10 patients (12% ) in the treated group were treated with antimicrobials at appropriate target therapeutic serum concentrations level .The 30 day mortal‐ity in the treated group was significantly higher than that in the control group ,even when matched the baseline morbidity of pa‐tients using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score .Conclusion This study revealed that MR‐SA colonization in the respiratory tract was frequently treated as pneumonia ,and antimicrobial dosage was frequently unsuitable .
