摘要
目的总结噬菌体治疗泌尿道复杂性泛耐药肺炎克雷伯菌感染的可行性及有效性。方法回顾性分析2019年8-9月上海市公共卫生临床中心收治的1例应用噬菌体治疗泌尿道复杂性泛耐药肺炎克雷伯菌感染患者的临床资料,并对相关文献进行复习。患者,女,65岁,因反复尿频、尿急6个月余于2019年8月6日人院。外院尿细菌培养结果示泛耐药肺炎克雷伯菌,反复应用头孢哌酮舒巴坦、左氧氣沙星等药物治疗,治疗后尿频、尿急可缓解,但停药后症状反复出现。2019年7月22曰本中心中段尿细菌培养结果示泛耐药肺炎克雷伯菌,拟行噬菌体灌注治疗。2019年8月9日起予117、135、178、00168号噬菌体混合液200ml膀胱灌注,每日1次,连续灌注5d。同时联合应用美罗培南+阿米卡星加强抗感染治疗。结果噬菌体灌注治疗后连续两次尿细菌培养阴性。但灌注结束后2周,患者再次出现尿频等不适,尿细菌培养结果示泛耐药肺炎克雷伯菌。2019年9月7日应用130、131、909号噬菌体混合液200ml膀胱灌注,每日1次,连续应用5d。并在治疗第3天行输尿管逆行插管双侧肾盂灌注上述3株噬菌体混合液。2次治疗过程均顺利,无并发症及不良反应。第2次治疗结束后随访6.5个月,患者未再出现尿频等排尿不适症状,且每月复查1次中段尿细菌培养,均未见泛耐药肺炎克雷伯菌。结论噬菌体泌尿道灌注治疗泛耐药肺炎克雷伯菌泌尿道感染疗效确切可靠,未见明显并发症和不良反应,可作为复杂性泛耐药肺炎克雷伯菌感染的一种可选择的治疗方案。
Objective To summarize the application of phage therapy in patients with urinary tract complicated panclrug-resistant Klebsiella pneumoniae infection,and analyze its feasibility and effectiveness.Methods To retrospec tively analyze the clinical data of a patient with complicated urinary tract complex pan-resistant Klebsiella pneumoniae treated by phage from August to September,2019 in Shanghai Public Health Clinical Center.The female patient,65 years old,was admitted to the hospital on August 6,2020.The patient repeated with frequent micturition and urgent micturition half a year before admission.These symptoms were not accompanied by back pain,fever,rh ills,dysuria,gross hematuria.Urinary culture results in outpatient hospital was pan-resistant Klebsiella pneumoniae.After the patient discontinued application of cefoperazone sulbactam,levofloxacin and other drugs,symptoms such as frequent urination could be relieved after treatment,but appeared repeatedly.In August 2019,the center innovatively applied phage therapy to treat this patient with urinary tract pandrug-resistant bacteria infection.Results For the first time,we applied 117,135,178,GDI68 phage mixed solution once a day,for 5 days of continuous bladder infusion.At the same time,meropenem and amikacin was intravenous administration to strengthened the anti-infection treatment.Urine culture was negative for two consecutive times after treatment.However,half a month after the end of the bladder infusion,the patient experienced discomfort such as frequent urination.Urine culture:pan-resistant Klebsiella pneumoniae.The second time,we applied a mixture of three phage strains 130,131,909,once a day,for 5 days of continuous bladder infusion.And in the afternoon of the third day of treatment,the renal pelvis was retrogradely intubated and perfused with the above three strains of phage mixture.During the second treatment follow-up until March 30,2020,the patienturine culture was reviewed once a month.As a result,no pan-resistant Klebsiella pneumoniae was found,and
作者
曾毅刚
包娟
谭德猛
张义元
郭明权
朱哲
邵恩明
朱同玉
Zeng Yigang;Bao Juan;Tan Demeng;Zhang Yiyiuin;Guo Mingquan;Zhu Zhe;Shao Enming;Zhu Tongyu(Department of Urology,Shanghai Public Health.Clinical Center,Shanghai 201508,China;Shanghai Institute of Phage,Shanghai Public:Health Clinical Center,Shanghai 201508,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2020年第9期677-680,共4页
Chinese Journal of Urology
基金
上海市临床重点专科传染病项目(shslczdzkO1102)。
关键词
感染
泌尿生殖系统
噬菌体
泛耐药肺炎克雷伯菌
Infection
Urogenital system
Phage
Pandrug-resistant Klebsiella pneumoniae
