红霉素对支气管扩张症患者呼吸道细菌的影响

发布时间：2018-06-28 09:19

本文选题：红霉素 + 支气管扩张症　；参考：《中国现代医学杂志》2017年17期

【摘要】：目的观察长期口服小剂量红霉素对稳定期支气管扩张症患者细菌耐药性的影响,以及呼吸道微生物群构成的变化。方法采取双盲、对照方法进行为期6个月的观察,纳入患者既往1年内有2次急性加重史,治疗组口服红霉素250 mg/次,2次/d,评估治疗前后两组急性加重次数的不同、呼吸道定植菌的耐药率变化,以及细菌构成的变化。结果 176例患者随机分组,治疗组90例,对照组86例;与对照组相比较,铜绿假单胞菌定植亚组的急性加重次数减少,但非铜绿定植亚组无变化;治疗组呼吸道革兰阴性菌群耐药率无变化,而革兰阳性菌群耐药率升高,尤其是对大环内酯类药物;治疗组较对照组痰菌负荷减少,微生物构成发生变化,但铜绿假单胞菌定植亚组患者微生物构成变化不大,非铜绿假单胞菌定植亚组微生物构成变化大,流感嗜血杆菌定植率降低,但耐大环内酯类药物细菌包括铜绿假单胞菌定植率升高。结论长期小剂量红霉素治疗造成支气管扩张症患者呼吸道革兰阳性菌群耐药率升高,尤其是对大环内酯类药物;呼吸道微生物群构成发生变化,在非铜绿假单胞菌定植亚组,急性加重次数并没有减少,而红霉素治疗使其流感嗜血杆菌定植率降低,但铜绿假单胞菌、金黄色葡萄球菌等对大环内酯类药物耐药的细菌定植率升高,该类患者尚需进一步寻找更好的治疗方案。
[Abstract]:Objective to observe the effect of long-term oral low dose erythromycin on bacterial resistance and microbial composition of respiratory tract in patients with stable bronchiectasis. Methods A double-blind, controlled study was carried out for 6 months, which included two acute exacerbations in one year. The patients in the treatment group were treated with erythromycin (Erythromycin) for 250 mg/ 2 / d, and the difference of the acute exacerbation times between the two groups was evaluated before and after the treatment. Changes in drug resistance rate and bacterial composition of respiratory tract colonizing bacteria. Results 176 patients were randomly divided into treatment group (n = 90) and control group (n = 86). In the treatment group, the resistance rate of Gram-negative bacteria was not changed, but the rate of Gram-positive bacteria resistance was increased, especially to macrolides, the load of sputum bacteria in the treatment group was lower than that in the control group, and the microbial composition was changed. However, the microbial composition of Pseudomonas aeruginosa colonized subgroup changed little, while that of non-Pseudomonas aeruginosa colonization subgroup changed greatly, and the colonization rate of Haemophilus influenzae decreased. But the colonization rate of macrolide resistant bacteria including Pseudomonas aeruginosa was increased. Conclusion the resistance rate of Gram-positive bacteria in respiratory tract of patients with bronchiectasis was increased after long-term low dose erythromycin treatment, especially for macrolides, and the composition of respiratory tract microflora was changed in non-Pseudomonas aeruginosa colonization subgroup. However, the colonization rate of Pseudomonas aeruginosa, Staphylococcus aureus and other macrolide resistant bacteria increased, while erythromycin treatment decreased the colonization rate of Haemophilus influenzae. This kind of patient still needs to look for better treatment plan further.
【作者单位】：河南省安阳市第三人民医院呼吸内科;郑州大学第一附属医院呼吸与危重症科;
【基金】：2014年河南省安阳市重大科技攻关项目(No:安财豫20140326)
【分类号】：R562.22

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