碳青霉烯类耐药铜绿假单胞菌感染治疗的研究进展
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摘要
目的对临床治疗碳青霉烯类耐药铜绿假单胞菌(CRPA)所致感染的研究进展进行综述,为临床治疗CRPA感染合理使用抗菌药物提供参考依据。方法查阅国内外有关CRPA耐药率、耐药机制和临床治疗CRPA感染的期刊文献,进行归纳总结。结果 CRPA对亚胺培南和美罗培南耐药率逐年升高,对碳青霉烯类抗生素耐药机制主要包括产生β-内酰胺酶、细胞外膜通透性改变、细菌主动外排作用、作用靶点发生改变和生物膜形成。临床主要采用以碳青霉烯类、多黏菌素、抗铜绿假单胞菌β内酰胺类为基础的联合治疗方案,或采用双β内酰胺联合、阿奇霉素联合环丙沙星、雾化吸入和局部用药等方案治疗CRPA的感染。结论针对CRPA所致感染的治疗困难,国内外的研究及指南均推荐采用联合用药方案治疗CRPA感染。
Objective To summarize the research progress in the clinical treatment of infection caused by carbapene-resistant Pseudomonas aeruginosa,in order to provide reference for clinical rational using antibiotics to treat carbapene-resistant Pseudomonas aeruginosa infection.Methods The domestic and abroad literatures on resistance rate,drug resistance mechanism and clinical treatment of carbapenem-resistant Pseudomonas aeruginosa were reviewed and summarized.Results The resistance rate of carbapene-resistant Pseudomonas aeruginosa to imipenem and meropenem increased year by year.The drug resistance mechanisms included the production of β-lactamase,the change of membrane permeability,the active efflux of bacteria,the change of target and the formation of biofilm.The combination therapy based on carbapenem and polymyxin were the main treatment.The combination of double β lactam,azithromycin combined with ciprofloxacin,aerosol inhalation and topical medication were also used.Conclusion It is difficult in treating infection caused by carbapenem-resistant Pseudomonas aeruginosa.Both domestic and foreign studies and guidelines recommend a combination of drugs for the treatment of carbapenem-resistant Pseudomonas aeruginosa infection.
Objective To summarize the research progress in the clinical treatment of infection caused by carbapene-resistant Pseudomonas aeruginosa,in order to provide reference for clinical rational using antibiotics to treat carbapene-resistant Pseudomonas aeruginosa infection.Methods The domestic and abroad literatures on resistance rate,drug resistance mechanism and clinical treatment of carbapenem-resistant Pseudomonas aeruginosa were reviewed and summarized.Results The resistance rate of carbapene-resistant Pseudomonas aeruginosa to imipenem and meropenem increased year by year.The drug resistance mechanisms included the production of β-lactamase,the change of membrane permeability,the active efflux of bacteria,the change of target and the formation of biofilm.The combination therapy based on carbapenem and polymyxin were the main treatment.The combination of double β lactam,azithromycin combined with ciprofloxacin,aerosol inhalation and topical medication were also used.Conclusion It is difficult in treating infection caused by carbapenem-resistant Pseudomonas aeruginosa.Both domestic and foreign studies and guidelines recommend a combination of drugs for the treatment of carbapenem-resistant Pseudomonas aeruginosa infection.
引文
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