期刊文章分类查询,尽在期刊图书馆一项更早的研究纳入了这类患者、但人数较少,发现接受多黏菌素联用替加环素治疗的患者总死亡率为30%(7/23),而接受黏菌素、替加环素联合延长输注美罗培南(1次2g、输注3小时或以上、每8小时1次)的患者中死亡率最低(12.5%,2/16)[5,6]。一项纳入了20项观察性研究的系统评价也总结到:联合治疗可为危重症患者带来生存收益[7]。本例患者的血培养回报为泛耐药的肺炎克雷伯菌感染,考虑为致病菌,药敏提示为CRKP。应用替加环素联合头孢哌酮钠舒巴坦钠7d患者症状及感染指标均好转,改为头孢哌酮钠舒巴坦钠联合亚胺培南西司他丁钠治疗24h,患者再次出现发热,白细胞及PCT等感染指标升高,改替加环素联合美罗培南抗感染治疗12d,患者无发热,感染指标降至正常出院。通过对该病例整个治疗过程的总结,提示替加环素联合美罗培南等碳青酶烯类药物为临床泛耐药的感染提供了新的治疗手段。参考文献[1] 汪明,孙自镛,陈中举,等.碳青霉烯类耐药的肠杆菌科细菌耐药机制研究[J].中华检验医学杂志,2012,35(4):339-34.[2] Spelman, Denis, Halvorsen, Dag S, Leong, Tim,etl. Large Outbreak of Infection and Colonization with Gram-Negative Pathogens Carrying the Metallo-β-Lactamase GeneblaIMP-4at a 320-Bed Tertiary Hospital in Australia [J]. Infection Control & Hospital Epidemiology, 2007,28(1):98-101.[3] Righi E,Peri A M ,Harris P N A , et al. Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis.[J]. J Antimicrob Chemother, 2017, 72(3):668-677.[4] Tamma P D , Goodman K E , Harris A D , et al. Comparing the Outcomes of Patients With Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Bacteremia.[J]. Clinical Infectious Diseases, 2016, 64(3):257.[5] Poirel, L. A nosocomial outbreak of Pseudomonas aeruginosa isolates expressing the extended-spectrum beta-lactamase GES-2 in South Africa[J]. Journal of Antimicrobial Chemotherapy, 2002,49(3):561-565.[6] Tumbarello M , Viale P , Viscoli C , et al. Predictors of Mortality in Bloodstream Infections Caused by Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae: Importance of Combination Therapy[J]. Clinical Infectious Diseases, 2012, 55(7):943-950.[7] Falagas M E , Lourida P , Poulikakos P , et al. Antibiotic Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae: Systematic Evaluation of the Available Evidence[J]. Antimicrobial Agents and Chemotherapy, 2014, 58(2):654-663.
论文作者:梁凯
论文发表刊物:《医师在线》2019年11月21期
论文发表时间:2020/3/5
标签:患者论文; 头孢论文; 肺炎论文; 菌血症论文; 白细胞论文; 杆菌论文; 克雷论文; 《医师在线》2019年11月21期论文;