摘要
目的:分析耐碳青霉烯类鲍曼不动杆菌(CRAB)感染的高危因素,研究体外联合药敏试验在临床治疗泛耐药鲍曼不动杆菌(PDR-AB)中的作用。方法:选取2011年1月至2011年12月在我院住院、鲍曼不动杆菌(AB)检测为阳性的患儿,分为CRAB组和碳青霉烯类敏感AB(CSAB)组,分析两组患儿在性别、年龄、基础疾病、曾住ICU比例、手术比例、标本来源、下呼吸道感染比例、病死率、耐药性、培养前抗菌药物使用种类、时间等情况。留取16株PDR-AB,用微量肉汤棋盘法分别测定氨苄西林/舒巴坦与美罗培南或头孢哌酮/舒巴坦体外联合药敏情况,计算分级抑菌浓度指数(FIC)。结果:CRAB组下呼吸道感染比例、病死率、第三代头孢菌素和碳青霉烯类抗菌药物使用率、常用抗菌药物耐药性、使用种类和使用时间均高于CSAB组,两组比较差异有统计学意义。体外联合药敏试验显示氨苄西林/舒巴坦联合美罗培南或头孢哌酮/舒巴坦,以相加作用为主,无协同和拮抗作用,美罗培南和氨苄西林/舒巴坦呈相加作用的患儿,使用该组合后有56.25%的治愈率。结论:临床使用第三代头孢菌素和碳青霉烯类抗菌药物比例高、频繁更换抗菌药物和使用时间长可能是CRAB出现的高危因素。体外联合药敏试验的结果与临床治疗结果存在相关性,可用于筛选泛耐药鲍曼不动杆菌的抗生素治疗方案。
Objective： To analyze the risk factors of Carbapenem-resistant Acinetobacter baumannii （CRAB） infections, and to study roles of combined sensitivity in vitro to treat pan-resistant Acinetobacter baumannii （PDR-AB） infections. Methods： All AB positive hospitalized cases from January 2011 to December 2011 were divided into a CRAB group and a Carbapenem-sensitive Acinetobacter baumannii （CSAB） group. The gender, age, underlying diseases, the proportion of hospitalizing in ICU, surgical proportion, specimen source, the proportion of lower respiratory tract infection, mortality, drug resistance, and types and time of antibiotics use before culture were analyzed. Specimens from sixteen PDR-AB isolates, with the broth checkerboard assay were tested ampicillin/sulbactam and meropenem or cefoperazone/sulbactam combined sensitivity in vitro, and fractional inhibitory concentration （FIC） was calculated. Results： The proportion of lower respiratory tract infections, mortality, resistance to commonly used antibiotics, and the usages and types of the third generation ccphalosporins and carbapenems in the CRAB group were all higher than those in the CSAB group. Combined susceptibility in vitro results showed ampicillin/sulbactam combined with meropcncm or cefoperazone/sulbactam had additive effects, no synergistic and antagonistic effects. If the combined sensitivity of meropencm and ampicillin/sulbactam in vitro in isolates of patients had additive effect, 56.25% of patients who used combination therapy were cured. Conclusions： Extensive use of the third- generation cephalosporins and carbapenem, frequent replacement of antibiotics and using antibiotics for a long time may be the risk factors of CRAB infections. Combined susceptibility results in vitro may correlate to clinical treatment outcomes. It may be useful for selection of PDR-AB therapies.
出处
《儿科药学杂志》
CAS
2013年第10期36-39,共4页
Journal of Pediatric Pharmacy
关键词
碳青霉烯类
鲍曼不动杆菌
联合药敏
Carbapenems
Acinetobacter baumannii
Combined sensitivity
