摘要
近年来,不动杆菌尤其是鲍曼不动杆菌已成为院内感染的常见病原菌,并呈现多重耐药甚至泛耐药趋势。不动杆菌感染病死率高、危害严重。2009年中国细菌耐药监测网(CHINET)的数据显示,不动杆菌最常见的感染部位为肺部,全球细菌耐药监测数据(SENTRY)显示,不动杆菌居医院获得性肺炎(HAP)常见致病原的第5位。如果从呼吸道分泌物中培养出不动杆菌,应判断其是定植还是感染;如果仅有阳性培养结果而无临床表现或影像学证据,可以暂不给予抗感染治疗。鲍曼不动杆菌对大部分抗菌药物的耐药率达50%或以上,应根据药敏结果选择敏感药物。对于耐碳青霉烯类不动杆菌尤其是泛耐药菌株感染,推荐选择舒巴坦或含舒巴坦的合剂。替加环素是第一个获准上市的甘氨酰环素类抗生素,体外实验已发现其对耐碳青霉烯类不动杆菌具有良好的抑菌活性。另外,预防不动杆菌肺炎在医疗机构中的暴发流行是降低不动杆菌肺炎发生率的重要措施之一。
Acinetobacter,especially Acinetobacter baumannii has emerged in recent years as a major cause of nosocomial infections,especially in intensive care units（ICUs）,due to its multidrug-resistance（MDR） even pan-drug-resistance（PDR） characteristics.Acinetobacter infection may lead to high mortality,and it is serious and detrimental to patients.In the year 2009,CHINET antimicrobial surveillance showed that lung was the most commonly infected organ,and SENTRY antimicrobial surveillance showed that Acinetobacter had become the top fifth cause of hospital-acquired pneumonia（HAP）,and its antibiotic resistance had gradually increased in these years.Colonization or infection of Acinetobacter should be determined at once when the bacteria were detected from culture of respiratory secretions.Generally,antibacterial treatment is not recommended if no clinical symptoms appear or imaging evidence unavailable.Since the resistance rate of Acinetobacter baumannii to most of the antibiotics reached 50% and above,an effective antibiotics should be carefully selected based on susceptibility test.Sulbactam or sulbactam-based composition is recommended for the carbapenem-resistant bacteria infection,particularly for infections caused by pan-resistant strains.As the first glycylcycline was approved to use in clinic,the anti-bacterial activity of Tigecycline against anti-carbapenem-resistant Acinetobacter has already been proven in vitro.In addition,the most important measure in controlling Acinetobacter pneumonia is to prevent the outbreak of Acinetobacter in medical institutions.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2011年第8期788-791,共4页
Medical Journal of Chinese People's Liberation Army
