Clincal Management of Pseudmonas Aeruginasa Pulmonary Infection：Difficulties，Insuffciency，and Excrss_Chinese Journal of Respiratory and Critical Care Medicine

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YANG Jin ¹ , QU Jieming ²

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Keywords：

铜绿假单胞菌; 肺部感染; ; 临床处理

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铜绿假单胞菌( Pseudomonas aeruginosa) 属于非发酵类假单胞菌, 广泛存在于自然界中, 也可广泛定植于人体消化道、呼吸道、皮肤及泌尿道等部位。20 世纪70 年代, 铜绿假单胞菌仅被认为是导致粒细胞缺乏患者发生致死性菌血症的病原体, 而到上世纪末及本世纪初, 铜绿假单胞菌已是医院获得性感染的主要病原体[ 1] 。在皮肤黏膜发生破坏( 如气管插管、烧伤、机械通气) , 免疫功能低下( 如中性粒细胞缺乏、细胞免疫功能缺陷) , 以及菌群失调的患者, 铜绿假单胞菌感染的发生率相当高。汪复等[ 2] 对国内主要地区的12所教学医院临床分离细菌资料的统计发现在所分离的革兰阴性菌中铜绿假单胞菌占16. 4% , 仅次于大肠埃希菌。在铜绿假单胞菌临床感染率不断增加的同时, 铜绿假单胞菌耐
药率逐渐增加, 特别是耐多药( MDR) 或者泛耐药( PDR) 铜绿假单胞菌的出现, 给临床治疗铜绿假单胞菌感染带来了更大的挑战。本文主要对目前临床上铜绿假单胞菌肺部感染
治疗中的难点及临床处理的过度与不足进行阐述。

Citation： YANG Jin,QU Jieming. Clincal Management of Pseudmonas Aeruginasa Pulmonary Infection：Difficulties，Insuffciency，and Excrss. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(6): 555-556. doi: Copy

1.	Kipnis E, Sawa T, Wiener-Kronish J. Targeting mechanisms of Pseudomonas aeruginosa pathogenesis. Med Mal Infect, 2006, 36 :78-91.
2.	汪复, 朱德妹, 胡付品, 等. 2008 年中国CHINET 细菌耐药性监测. 中国感染与化疗杂志, 2009, 9 : 321-329.
3.	倪语星. 2005 年中国CHINET 铜绿假单胞菌耐药性分析. 中国感染与化疗杂志, 2007, 7 : 274-278.
4.	周庆涛, 姚婉贞, 陈亚红, 等. 2001 ～2005 年呼吸科病房临床分离菌的变迁及耐药性分析监测. 中国感染与化疗杂志, 2007, 7 :53-57.
5.	Carmeli Y, Troillet N, Eliopoulos GM, et al. Emergence of antibiotic -resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother, 1999, 43: 1379-1382.
6.	Rossolini GM, Mantengoli E. Treatment and control of severe infections caused by multiresistant Pseudomonas aeruginosa. Clin Microbiol Infect, 2005 , 11( Suppl 4) : 17 -32 .
7.	Livermore DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis,2002, 34: 634-640 .
8.	Chamot E, Boffi El Amari E, Rohner P, et al. Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother, 2003, 47: 2756-2764.
9.	American Thoracic Society; Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416 .
10.	李鸿雁, 夏前明. 细菌生物被膜与难治性呼吸道感染. 中国感染与化疗杂志, 2004 , 4: 190-192 .
11.	Wozniak DJ, Keyser R. Effects of subinhibitory concentrations of macrolide antibiotics on Pseudomonas aeruginosa. Chest, 2004, 125 ( 2 Suppl) : 62S-69S.
12.	Hassett DJ, Korfhagen TR, Irvin RT, et al. Pseudomonas aeruginosa biofilm infections in cystic fibrosis: insights into pathogenic processes and treatment strategies. Expert Opin Ther Targets, 2010 ,14: 117-130 .
13.	彭程, 肖永红. 大环内酯类药物对铜绿假单胞菌生物膜形成的影响. 中国抗生素杂志, 2001, 26 : 286-289 .
14.	Lodise TP Jr, Patel N, Kwa A, et al. Predictors of 30-day mortality among patients with Pseudomonas aeruginosa bloodstream infections: impact of delayed appropriate antibiotic selection.Antimicrob Agents Chemother, 2007, 51 : 3510 -3515 .

1. Kipnis E, Sawa T, Wiener-Kronish J. Targeting mechanisms of Pseudomonas aeruginosa pathogenesis. Med Mal Infect, 2006, 36 :78-91.
2. 汪复, 朱德妹, 胡付品, 等. 2008 年中国CHINET 细菌耐药性监测. 中国感染与化疗杂志, 2009, 9 : 321-329.
3. 倪语星. 2005 年中国CHINET 铜绿假单胞菌耐药性分析. 中国感染与化疗杂志, 2007, 7 : 274-278.
4. 周庆涛, 姚婉贞, 陈亚红, 等. 2001 ～2005 年呼吸科病房临床分离菌的变迁及耐药性分析监测. 中国感染与化疗杂志, 2007, 7 :53-57.
5. Carmeli Y, Troillet N, Eliopoulos GM, et al. Emergence of antibiotic -resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother, 1999, 43: 1379-1382.
6. Rossolini GM, Mantengoli E. Treatment and control of severe infections caused by multiresistant Pseudomonas aeruginosa. Clin Microbiol Infect, 2005 , 11( Suppl 4) : 17 -32 .
7. Livermore DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis,2002, 34: 634-640 .
8. Chamot E, Boffi El Amari E, Rohner P, et al. Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother, 2003, 47: 2756-2764.
9. American Thoracic Society; Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416 .
10. 李鸿雁, 夏前明. 细菌生物被膜与难治性呼吸道感染. 中国感染与化疗杂志, 2004 , 4: 190-192 .
11. Wozniak DJ, Keyser R. Effects of subinhibitory concentrations of macrolide antibiotics on Pseudomonas aeruginosa. Chest, 2004, 125 ( 2 Suppl) : 62S-69S.
12. Hassett DJ, Korfhagen TR, Irvin RT, et al. Pseudomonas aeruginosa biofilm infections in cystic fibrosis: insights into pathogenic processes and treatment strategies. Expert Opin Ther Targets, 2010 ,14: 117-130 .
13. 彭程, 肖永红. 大环内酯类药物对铜绿假单胞菌生物膜形成的影响. 中国抗生素杂志, 2001, 26 : 286-289 .
14. Lodise TP Jr, Patel N, Kwa A, et al. Predictors of 30-day mortality among patients with Pseudomonas aeruginosa bloodstream infections: impact of delayed appropriate antibiotic selection.Antimicrob Agents Chemother, 2007, 51 : 3510 -3515 .

Chinese Journal of Respiratory and Critical Care Medicine

Clincal Management of Pseudmonas Aeruginasa Pulmonary Infection：Difficulties，Insuffciency，and Excrss

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