多药耐药革兰阴性菌肺炎的抗感染治疗_Chinese Journal of Respiratory and Critical Care Medicine

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曹彬

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Keywords：

多药耐药; 革兰阴性菌; 肺炎; 感染

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铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌是最容易产生对多种抗生素耐药的院内致病菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐万古霉素肠球菌(VRE)的定义相对简单，只要对一种有代表性的抗生素产生耐药就可以了。但是，给多药耐药或者泛耐药的革兰阴性杆菌下定义则较为困难 ]。一般来讲，如果对下列5种抗生素中两种以上耐药称为多药耐药：包括对铜绿假单胞菌有活性的头孢菌素类、碳青霉烯类、加酶抑制剂的B一内酰胺类；对铜绿假单胞菌有活性的氟喹诺酮类、氨基糖苷类。如果仅对多黏菌素敏感，但是对目前所有的抗生素都耐药则称为泛耐药(Pandrug—resistant)。一方面，多药耐药或泛耐药的革兰阴性菌感染逐渐增多；另一方面，许多大的制药企业逐渐放弃了新抗生素的研发，尤其是针对革兰阴性菌的抗生素研发更少。人们惊呼：后抗生素时代(post—antibiotic era)真的来临了吗 7我们如何应对?

Citation： 曹彬. 多药耐药革兰阴性菌肺炎的抗感染治疗. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(1): 3-5. doi: Copy

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5.	Bratu S，Tolaney P，Karumudi U，et a1．Carbapenemase—pro— ducing Klebsiella pneumoniae in Brooklyn，NY：molecular epidemiology an d in vitro activity of polymyxin B and other agents．J Antimicrob Chemother，2005，56：128—132.
6.	Dubois V，Arpin C，Melon M，et a1．Nosocomial outbreak due to a multiresistant strain of Pseudomonas aeruginosa P12：eficacy of cefepime—amikacin therapy an d analysis of beta—lactam resistance．J Clin Microbiol，2001，39：2072— 2078.
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9.	Linden PK，Kusne S，Coley K。et a1．Use of parenteral colis— tin for the treatment of serious infection due to antimicrobi— al-resistan t Pseudomonas aeFuginosa．Clin Infect Dis，2003， 37：e154-el60. 9 Markou N，Apostolakos H ，Koumoudiou C，et a1．In~avenous colistin in the treatment of sepsis from multiresistant Gram. negative bacilli in critically ill patients．Crit Care，2003，7： R78一R83.
10.	Kasiakou SK，Michalopoulos A，Soteriades ES，et a1．Combination therapy with intravenous colistin for management of infections due to multidrug·-resistant Gram·-negative bacteria in patients wi thout cystic fibrosis．Antimicrob Agents Chemo 山er，2005，49：3136-3146.
11.	Michalopoulos A，Kasiakou SK，Mastora Z，et a1．Aerosolized colistin for the treatment of nosocomial pneumonia due to muhidrug--resistant Gram--negative bacteria in patients without cystic fibrosis．Crit Care，2005，9：R53一R59.
12.	Landman D，Bratu S，Alam M ，et a1．Citywide emergence of Pseudomonas aeruginosa strains with reduced susceptibility to polymyxin B．J Antimicrob Chemother，2005．55：954— 957.
13.	Souli M ，Kontopidou FV，Koratzanis E，et a1．In vitro activity of tigecycline against multiple-drug-resistant，including pan— resistant，gram -negative and gram—positive clinical isolates from Greek hospitals．Antimicrob Agents Chemother，2006， 50：3166-3169.
14.	Taccone FS，Rodriguez—Villalobos H ，De Backer D，et a1. Successful treatment of septic shock due to pan—resistan t Acinetobacter baumannii using combined antimicrobial therapy including tigecycline．Eur J Clin Microbiol Infect Dis， 2006，25：257-260.
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1. Paterson DL．The epidemiological profile of infections with muhidrug--resistant Pseudomonas aeruginosa and Acineto-- bacter species．Clin Infect Dis，2006。43(Suppl 2)：$43- S48.
2. 1 Sobieszczyk ME，Furuya EY，Hay CM ，et a1．Combination therapy with polymyxin B for the treatment of muhidrug·-re·- sistan t Gram -negative respiratory tract infections．J Antimi— crob Chemother，2004，54：566-569.
3. Falagas ME，Bliziotis IA．Pandrug-resistan t Gram—negative bacteria：the dawn of the post—antibiotic era?Int J Antimi— crob Agents，2007，29：630-636.
4. Rahal JJ．Novel antibiotic combinations against infections with almost completely resistant Pseudomonas aeFuginosa and Acinetobacter species．Clin Infect Dis，2006，43(Suppl 2)：$95一$99.
5. Bratu S，Tolaney P，Karumudi U，et a1．Carbapenemase—pro— ducing Klebsiella pneumoniae in Brooklyn，NY：molecular epidemiology an d in vitro activity of polymyxin B and other agents．J Antimicrob Chemother，2005，56：128—132.
6. Dubois V，Arpin C，Melon M，et a1．Nosocomial outbreak due to a multiresistant strain of Pseudomonas aeruginosa P12：eficacy of cefepime—amikacin therapy an d analysis of beta—lactam resistance．J Clin Microbiol，2001，39：2072— 2078.
7. Levin AS，Barone AA，Pen~o J，et a1．Intravenous colistin as therapy for nosocomial infections caused by muhidrug·-re-- sistant Pseudomonas aeruginosa and Acinetobacter bauman— nii．Clin Infect Dis，1999，28：1008—1011.
8. Garnacho—Montero J．Ortiz—Leyba C，Jimrnez-Jimrnez FJ，et a1．Treatment of multidrug-resistant Acinetobacter baumannii ventilator—associated pneumonia(VAP)with intravenous colistin：a comparison with imipenem—susceptible VAP．Clin Infect Dis，2003，36：1111-l118.
9. Linden PK，Kusne S，Coley K。et a1．Use of parenteral colis— tin for the treatment of serious infection due to antimicrobi— al-resistan t Pseudomonas aeFuginosa．Clin Infect Dis，2003， 37：e154-el60. 9 Markou N，Apostolakos H ，Koumoudiou C，et a1．In~avenous colistin in the treatment of sepsis from multiresistant Gram. negative bacilli in critically ill patients．Crit Care，2003，7： R78一R83.
10. Kasiakou SK，Michalopoulos A，Soteriades ES，et a1．Combination therapy with intravenous colistin for management of infections due to multidrug·-resistant Gram·-negative bacteria in patients wi thout cystic fibrosis．Antimicrob Agents Chemo 山er，2005，49：3136-3146.
11. Michalopoulos A，Kasiakou SK，Mastora Z，et a1．Aerosolized colistin for the treatment of nosocomial pneumonia due to muhidrug--resistant Gram--negative bacteria in patients without cystic fibrosis．Crit Care，2005，9：R53一R59.
12. Landman D，Bratu S，Alam M ，et a1．Citywide emergence of Pseudomonas aeruginosa strains with reduced susceptibility to polymyxin B．J Antimicrob Chemother，2005．55：954— 957.
13. Souli M ，Kontopidou FV，Koratzanis E，et a1．In vitro activity of tigecycline against multiple-drug-resistant，including pan— resistant，gram -negative and gram—positive clinical isolates from Greek hospitals．Antimicrob Agents Chemother，2006， 50：3166-3169.
14. Taccone FS，Rodriguez—Villalobos H ，De Backer D，et a1. Successful treatment of septic shock due to pan—resistan t Acinetobacter baumannii using combined antimicrobial therapy including tigecycline．Eur J Clin Microbiol Infect Dis， 2006，25：257-260.
15. Jones RN，Huynh HK，Biedenbach DJ．Activities of doripen— em(S-466 1)against drug—resistant clinical pathogens．Antimicrob Agents Chemother，2O04，48：3136—3140．.

Chinese Journal of Respiratory and Critical Care Medicine

多药耐药革兰阴性菌肺炎的抗感染治疗

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