碳青霉烯耐药鲍曼不动杆菌所致老年患者医院获得性肺炎的抗菌药物治疗

发布时间：2018-05-05 09:41

  本文选题：鲍曼不动杆菌 + 碳青霉烯　； 参考：《中国人民解放军军医进修学院》2012年硕士论文

【摘要】：1、目的：(1)回顾性分析我院2008-2011年临床分离的碳青霉烯类耐药鲍曼不动杆菌(CRAB)所致老年患者医院获得性肺炎(HAP)病例,总结临床特点、易患因素及鲍曼不动杆菌耐药表型,为临床合理应用抗菌药物提供参考。(2)对CRAB进行体外联合药敏试验,寻找对CRAB有效的药物组合。(3)检测我院CRAB的主要碳青霉烯酶基因型,研究临床分离的CRAB耐药机制。 2、方法：(1)制定病例调查表,收集71例CRAB所致老年患者HAP病例的基本情况、既往应用抗生素的种类,基础疾病,临床表现,药敏结果及治疗转归等,寻找易感因素,明确所致感染的临床特点及预后情况。(2)采用棋盘法设计微量肉汤稀释法对60株CRAB进行不同药物组合的体外联合抑菌试验：所选用的抗菌药物组合包括：头孢哌酮/舒巴坦(CFS)+利福平(RFP),头孢哌酮/舒巴坦+米诺环素(MIN),头孢哌酮/舒巴坦+美罗培南(MER),头孢哌酮/舒巴坦+左氧氟沙星(LEV)及美罗培南+米诺环素,并计算联合抑菌指数(FIC指数),判断联合效应。(3)收集我院老年病房CRAB60株,用PCR扩增方法检测60株CRAB的碳青霉烯酶基因型。3、结果：(1)CRAB所致老年患者HAP多发生在基础疾病患者,死亡组的APACHE Ⅱ评分(25.78±4.35)明显高于生存组(18.07±6.5)且P0.05。治疗中使用头孢哌酮/舒巴坦的一组患者的30天生存率明显高于另一组(P0.05)。(2)CFS与RFP联用后,80.0%为协同作用,16.7%为相加作用,3.3%为无关作用,无拮抗作用；CFS与MIN联用后,11.7%为协同作用,45.0%为相加作用,35.0%为无关作用,8.3%为拮抗作用；CFS与LEV联用时,6.7%为协同作用,40.0%为相加作用,53.3%为无关作用,无拮抗作用。MER与CFS联用后,28.3%为协同作用,53.4%为相加作用,18.3%为无关作用,无拮抗。MER与MIN联用后,10.0%为协同作用,75.0%为相加作用,15.0%为无关作用,无拮抗。各组药物联用后,浓度-累积抑菌百分率曲线均左移。(3)60株CRAB中,扩增出OXA-23及OXA-51基因均为58株(96.7%),同一株菌同时扩增出OXA-23及OXA-51基因的有57株（95.0%），，未增出OXA-24、OXA-58、SIM、VIM IMP耐因。4、结论：（1）CRAB所致老年患者HAP死亡预与APACHEⅡ评分有关；CFS治疗CRAB老年HAP有一定疗效。（2）CFS与RFP、MIN、MER MER与MIN联用时对CRAB效应主表现为协同和加作用。CFS与LEV联用主表现为无关作用,但有一部分表现为协同和加作用。（3）我院流行CRAB碳青 烯因型主为OXA-23和OXA-51型。
[Abstract]:Objective: to analyze retrospectively the clinical characteristics, susceptible factors and phenotype of Acinetobacter baumannii in the elderly patients with nosocomial pneumonia caused by carbapenem resistant Acinetobacter baumannii (CRA) from 2008 to 2011 in our hospital. To provide a reference for the rational use of antimicrobial agents in clinic, combined drug sensitivity test for CRAB in vitro was carried out to find out the effective combination of carbapenem genotypes of CRAB in our hospital, and to study the mechanism of CRAB resistance in clinical isolation. 2. Methods A case questionnaire was made to collect the basic information of 71 cases of HAP caused by CRAB, the kinds of antibiotics, the basic diseases, the clinical manifestations, the results of drug sensitivity and the outcome of treatment, and to find out the susceptible factors. To determine the clinical characteristics and prognosis of the infection. (2) A chessboard method was used to design a broth dilution method for the in vitro combined bacteriostatic test of 60 CRAB strains with different drug combinations. The antimicrobial combinations selected included: cefoperazone. / sulbactam CFS) rifampicin, cefoperazone / sulbactam minocycline, cefoperazone / sulbactam meropenem, cefoperazone / sulbactam levofloxacin, LEV) and meropenem minocycline, The CRAB60 strains in geriatric wards were collected and detected by PCR amplification method. The results showed that the HAP of 60 CRAB strains were mostly found in the patients with basic diseases. The APACHE 鈪

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