ICU多重耐药铜绿假单胞菌感染肺炎的治疗及降钙素原对抗菌药物使用的指导意义
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摘要
目的探讨ICU多重耐药铜绿假单胞菌感染肺炎的临床治疗对策,以及降钙素原对临床抗菌药物使用的指导意义。方法选取2012年1月至2017年12月温州医科大学附属第二医院ICU病房收治的经痰液样本分离出的铜绿假单胞菌感染肺炎患者142例,根据药敏试验结果分为非多重耐药菌种和多重耐药菌,每组71例,对两组患者分别使用抗菌药物进行治疗,对其临床效果进行探讨。同时,在治疗前及治疗后7 d、 14 d、21 d对71例ICU多重耐药铜绿假单胞菌感染肺炎患者降钙素原进行检测,对比使用一种抗菌药物和两种及以上抗菌药物在治疗前后的降钙素原,以及治疗后炎性指标的情况。结果非多重耐药菌种采用一种抗菌药物治疗的效果低于两种及以上抗菌药物治疗效果,两组相比差异无统计学意义(χ~2=0.137,P>0.05),多重耐药菌种采用一种抗菌药物治疗的效果低于两种及以上抗菌药物治疗效果,两组相比差异有统计学意义(χ~2=21.384,P<0.05);观察组与治疗组患者治疗前PCT检测结果差异无统计学意义(t=0.259,P>0.05);治疗后,两组PCT检测结果均有改善,观察组改善优于对照组,两组相比差异有统计学意义(t=4.572、6.839、11.287,P<0.05);治疗结束后,观察组CRP、白细胞计数、IL-6均低于对照组,两组差异有统计学意义(t=19.652、7.384、28.391,P<0.05)。结论 ICU铜绿假单胞菌感染肺炎患者应选用两种及以上抗菌药物进行治疗,PCT的检测对ICU多重耐药铜绿假单胞菌感染肺炎抗菌药物的使用起到指导性的作用。
Objective To explore the clinical treatment strategies of patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia in ICU, and to discuss the clinical guidance of procalcitonin for the use of antibiotics. Methods A total of 142 patients with pneumonia caused by Pseudomonas aeruginosa isolated from the sputum samples in ICU from January 2012 to December 2017 were enrolled and divided into non-multi-drug resistant strain group(71 cases) and multi-drug-resistant bacteria group(71 cases) according to the results of drug susceptibility test.All subjects were treated with antibiotics and the therapeutic effects were discussed and compared.Meanwhile, procalcitonin was measured in 71 cases with multi-drug-resistant Pseudomonas aeruginosa pneumonia before treatment and 7 d, 14 d and 21 d after treatment with one or more antibiotics to compare the changes of procalcitonin. Results The therapeutic effect of one antibacterial drug to treat non-multi-drug-resistant Pseudomonas aeruginosa pneumonia was slightly lower than that of two or more antibacterial drugs with no significant difference(χ~2=0.137,P>0.05),while the effect was much lower for multi-drugresistant Pseudomonas aeruginosa pneumonia treatment with significant difference(χ~2=21.384,P<0.05).The PCT levels were similar between the two groups before treatment(t=0.259,P>0.05).However,after treatment,the PCT levels in both groups were improved,especially in patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia(t=4.572,6.839,11.287,P<0.05).After the treatment,CRP,white blood cell count and IL-6 level in patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia were significantly lower compared to those with non-multi-drug-resistant Pseudomonas aeruginosa pneumonia,the differences were statistically significant(t=19.652,7.384,28.391,P< 0.05). Conclusions Patients with Pseudomonas aeruginosa pneumonia should be treated with two or more antibacterial drugs.PCT detection may play aguiding role in the use of antibiotics for multi-drug-resistant Pseudomonas aeruginosa pneumonia treatment.
Objective To explore the clinical treatment strategies of patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia in ICU, and to discuss the clinical guidance of procalcitonin for the use of antibiotics. Methods A total of 142 patients with pneumonia caused by Pseudomonas aeruginosa isolated from the sputum samples in ICU from January 2012 to December 2017 were enrolled and divided into non-multi-drug resistant strain group(71 cases) and multi-drug-resistant bacteria group(71 cases) according to the results of drug susceptibility test.All subjects were treated with antibiotics and the therapeutic effects were discussed and compared.Meanwhile, procalcitonin was measured in 71 cases with multi-drug-resistant Pseudomonas aeruginosa pneumonia before treatment and 7 d, 14 d and 21 d after treatment with one or more antibiotics to compare the changes of procalcitonin. Results The therapeutic effect of one antibacterial drug to treat non-multi-drug-resistant Pseudomonas aeruginosa pneumonia was slightly lower than that of two or more antibacterial drugs with no significant difference(χ~2=0.137,P>0.05),while the effect was much lower for multi-drugresistant Pseudomonas aeruginosa pneumonia treatment with significant difference(χ~2=21.384,P<0.05).The PCT levels were similar between the two groups before treatment(t=0.259,P>0.05).However,after treatment,the PCT levels in both groups were improved,especially in patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia(t=4.572,6.839,11.287,P<0.05).After the treatment,CRP,white blood cell count and IL-6 level in patients with multi-drug-resistant Pseudomonas aeruginosa pneumonia were significantly lower compared to those with non-multi-drug-resistant Pseudomonas aeruginosa pneumonia,the differences were statistically significant(t=19.652,7.384,28.391,P< 0.05). Conclusions Patients with Pseudomonas aeruginosa pneumonia should be treated with two or more antibacterial drugs.PCT detection may play aguiding role in the use of antibiotics for multi-drug-resistant Pseudomonas aeruginosa pneumonia treatment.
引文
[1] 贺利平.血清降钙素原监测在ICU多重耐药菌感染抗生素治疗的应用[J/CD].世界最新医学信息文摘:连续型电子期刊,2015,9(65):46-47.
[2] 陈矛,姜悦,黄樱菲,等.ICU病房多重耐药菌感染降钙素原监测的应用[J].中国医学工程,2016,24(2):125-127.
[3] Dupont H,Marciniak S,Zogheib E,et al.Use of aztreonam in association with cefepime for the treatment of nosocomial infections due to multidrug-resistant strains of Pseudomonas aeruginosa to β-lactams in ICU patients:A pilot study[J].Anaesth Crit Care Pain Med,2015,34(3):141-144.
[4] Zilberberg MD,Shorr AF,Micek ST,et al.Multi-drug resistance,inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock:a retrospective cohort study[J].Crit Care,2014,18(6):1-13.
[5] 赖军华,李敏.血清降钙素原监测在ICU多重耐药菌感染抗生素治疗的应用[J].中国医药导报,2012,9(14):75-76.
[6] Martínloeches I,Diaz E,Vallés J.Risks for multidrug-resistant pathogens in the ICU[J].Curr Opin Crit Care,2014,20(5):516-524.
[7] Timsit JF,Harbarth S,Carlet J.De-escalation as a potential way of reducing antibiotic use and antimicrobial resistance in ICU[J].Intensive Care Med,2014,40(10):1580.
[8] 尚红,王毓三,申子瑜.全国临床检验操作规程[M].4 版.北京:人民卫生出版社,2015.
[9] 《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则:2015年版[M].北京:人民卫生出版社,2015.
[10] Alotair HA,Hussein MA,Elhoseny MA,et al.Severe pneumonia requiring ICU admission:Revisited[J].J Taib Univers Med Sci,2015,10(3):293-299.
[11] Lee Hongyeul,Park Ji Young,Lee Taehoon,et al.Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia[J].Korean J Intern Med,2016,31(3):525-534.
[12] 刘维高.氯霉素联合红霉素治疗多重耐药铜绿假单胞菌肺炎21例临床分析[J].现代医药卫生,2011,27(14):2109-2110.
[13] Zhang Y,Brackman G,Coenye T.Pitfalls associated with evaluating enzymatic quorum quenching activity:the case of MomL and its effect on Pseudomonas aeruginosa and Acinetobacter baumannii biofilms[J].Peerj,2017,5(6):e3251.
[14] 胡光友,葛香丽,赵宝利,等.ICU感染多重耐药铜绿假单胞菌肺炎的临床治疗[J].中国实用医刊,2014,41(17):6-8.
[15] Hou W,Xiao Q,Jiang L,et al.Research on the clinical significance of serum procalcitonin in predicting bacteremia[J].Laborat Med,2014,29(8):802-805.
[16] 刘娟.血清降钙素原监测用于ICU多重耐药菌感染抗生素治疗的临床分析[J].世界临床医学,2017,11(1):75-76.
[17] Liu D,Su L,Guan W,et al.Prognostic value of procalcitonin in pneumonia:A systematic review and meta‐analysis[J].Respirol,2016,21(2):280-288.
[18] 黄新文,王晋鹏,李海林,等.血清C-反应蛋白与降钙素原水平对细菌性脓毒症的诊断价值[J].中华医学杂志,2014,94(27):2106-2109.
[19] 君洛,张敬芝,王亨,等.降钙素原监测在 ICU 病房多重耐药菌感染患者应用中的评价[J].中国医药指南,2013,11(26):83-84.
[20] 吕丽燕,李剑锋,潘丽.血清降钙素原监测对机械通气患者呼吸机相关性肺炎的诊断价值[J].海南医学,2016,27(3):415-417.
[21] 顾忠民,吴荣华.PCT 在ICU 多重耐药菌 MDR 的定植与感染鉴别中的应用[J].中国医药科学,2012,2(11):90-91.
[22] Sager R,Kutz A,Mueller B,et al.Procalcitonin-guided diagnosis and antibiotic stewardship revisited[J].Bmc Med,2016,15(1):15.
[2] 陈矛,姜悦,黄樱菲,等.ICU病房多重耐药菌感染降钙素原监测的应用[J].中国医学工程,2016,24(2):125-127.
[3] Dupont H,Marciniak S,Zogheib E,et al.Use of aztreonam in association with cefepime for the treatment of nosocomial infections due to multidrug-resistant strains of Pseudomonas aeruginosa to β-lactams in ICU patients:A pilot study[J].Anaesth Crit Care Pain Med,2015,34(3):141-144.
[4] Zilberberg MD,Shorr AF,Micek ST,et al.Multi-drug resistance,inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock:a retrospective cohort study[J].Crit Care,2014,18(6):1-13.
[5] 赖军华,李敏.血清降钙素原监测在ICU多重耐药菌感染抗生素治疗的应用[J].中国医药导报,2012,9(14):75-76.
[6] Martínloeches I,Diaz E,Vallés J.Risks for multidrug-resistant pathogens in the ICU[J].Curr Opin Crit Care,2014,20(5):516-524.
[7] Timsit JF,Harbarth S,Carlet J.De-escalation as a potential way of reducing antibiotic use and antimicrobial resistance in ICU[J].Intensive Care Med,2014,40(10):1580.
[8] 尚红,王毓三,申子瑜.全国临床检验操作规程[M].4 版.北京:人民卫生出版社,2015.
[9] 《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则:2015年版[M].北京:人民卫生出版社,2015.
[10] Alotair HA,Hussein MA,Elhoseny MA,et al.Severe pneumonia requiring ICU admission:Revisited[J].J Taib Univers Med Sci,2015,10(3):293-299.
[11] Lee Hongyeul,Park Ji Young,Lee Taehoon,et al.Intermediate risk of multidrug-resistant organisms in patients who admitted intensive care unit with healthcare-associated pneumonia[J].Korean J Intern Med,2016,31(3):525-534.
[12] 刘维高.氯霉素联合红霉素治疗多重耐药铜绿假单胞菌肺炎21例临床分析[J].现代医药卫生,2011,27(14):2109-2110.
[13] Zhang Y,Brackman G,Coenye T.Pitfalls associated with evaluating enzymatic quorum quenching activity:the case of MomL and its effect on Pseudomonas aeruginosa and Acinetobacter baumannii biofilms[J].Peerj,2017,5(6):e3251.
[14] 胡光友,葛香丽,赵宝利,等.ICU感染多重耐药铜绿假单胞菌肺炎的临床治疗[J].中国实用医刊,2014,41(17):6-8.
[15] Hou W,Xiao Q,Jiang L,et al.Research on the clinical significance of serum procalcitonin in predicting bacteremia[J].Laborat Med,2014,29(8):802-805.
[16] 刘娟.血清降钙素原监测用于ICU多重耐药菌感染抗生素治疗的临床分析[J].世界临床医学,2017,11(1):75-76.
[17] Liu D,Su L,Guan W,et al.Prognostic value of procalcitonin in pneumonia:A systematic review and meta‐analysis[J].Respirol,2016,21(2):280-288.
[18] 黄新文,王晋鹏,李海林,等.血清C-反应蛋白与降钙素原水平对细菌性脓毒症的诊断价值[J].中华医学杂志,2014,94(27):2106-2109.
[19] 君洛,张敬芝,王亨,等.降钙素原监测在 ICU 病房多重耐药菌感染患者应用中的评价[J].中国医药指南,2013,11(26):83-84.
[20] 吕丽燕,李剑锋,潘丽.血清降钙素原监测对机械通气患者呼吸机相关性肺炎的诊断价值[J].海南医学,2016,27(3):415-417.
[21] 顾忠民,吴荣华.PCT 在ICU 多重耐药菌 MDR 的定植与感染鉴别中的应用[J].中国医药科学,2012,2(11):90-91.
[22] Sager R,Kutz A,Mueller B,et al.Procalcitonin-guided diagnosis and antibiotic stewardship revisited[J].Bmc Med,2016,15(1):15.