銅綠假單胞菌( Pseudomonas aeruginosa) 屬于非發酵類假單胞菌, 廣泛存在于自然界中, 也可廣泛定植于人體消化道、呼吸道、皮膚及泌尿道等部位。20 世紀70 年代, 銅綠假單胞菌僅被認為是導致粒細胞缺乏患者發生致死性菌血癥的病原體, 而到上世紀末及本世紀初, 銅綠假單胞菌已是醫院獲得性感染的主要病原體[ 1] 。在皮膚黏膜發生破壞( 如氣管插管、燒傷、機械通氣) , 免疫功能低下( 如中性粒細胞缺乏、細胞免疫功能缺陷) , 以及菌群失調的患者, 銅綠假單胞菌感染的發生率相當高。汪復等[ 2] 對國內主要地區的12所教學醫院臨床分離細菌資料的統計發現在所分離的革蘭陰性菌中銅綠假單胞菌占16. 4% , 僅次于大腸埃希菌。在銅綠假單胞菌臨床感染率不斷增加的同時, 銅綠假單胞菌耐藥率逐漸增加, 特別是耐多藥( MDR) 或者泛耐藥( PDR) 銅綠假單胞菌的出現, 給臨床治療銅綠假單胞菌感染帶來了更大的挑戰。本文主要對目前臨床上銅綠假單胞菌肺部感染治療中的難點及臨床處理的過度與不足進行闡述。
ObjectiveTo analyze and summarize the clinical characteristics, risk factors, pathogenic bacteria type, and drug tolerance of diabetes complicated with hospital-acquired pulmonary infection, in order to reduce the incidence of hospital-acquired pulmonary infection in patients with diabetes. MethodsThe clinical data of diabetic patients with hospital-acquired pulmonary infection from 2011 to 2013 were taken for retrospective clinical analysis. ResultsA total of 78 diabetic patients had hospital-acquired pulmonary infection among all the 572 hospitalized patients with diabetes. Age, complications of diabetes, chronic underlying disease, duration of hospital stay, glycated hemoglobin and invasive procedures were all correlated with the incidence of hospital-acquired infection (P<0.05). Through sputum culture and throat culture, 59 strains of pathogens were found, and they were mainly multidrug-resistant Gram-negative bacteria, accounting for 71.2%. ConclusionThe rate of acquired pulmonary infection in diabetic patients is particularly high, and the pathogens are mostly Gram-negative and multidrug-resistant. Glycemic control, rational use of antimicrobial drugs, shorter hospital stay, effective prevention and treatment of diabetes complications and chronic underlying diseases, and aseptic techniques can be effective in preventing acquired pulmonary infection for diabetic patients.
Objective To explore the clinical epidemiological characteristics of the lung infection after orthotopical liver transplantation. Methods The clinical data included infection morbidity, mortality, infectious times and relative factors, clinical manifestations, the bacterial strains and distributions of the pathogens, the bacterial resistances of the 53 liver transplantation recipients from 2003.3～2006.12 were summarized and analyzed retrospectively. Results Among 53 recipients, 33 developed lung infectious and 6 died .The mobidity was 62.3% and mortality was 18.2%, with a OR of 1.0. Lung infection predominantly occurred in the first month, especially in the first week after transplantation.There were many factors related to lung infections.Various pathogens, especially Klebsialla, Escherichia Coli and Staphylococus Hominis were isolated from sputum, airway suction drainages and throat swabs. Most of the G- bacteria were sensitive to aminoglycosides,β lactam and lactamase compounds and carbapenems while G+ bacteria were sensitive only to glycopeptides. All the bacteria were resistant to quinolones, β lactams of third and forth generation. Conclusions After liver transplantation, the morbidity and mortality of the lung infections are high.The infections develope at earlier stage, manifest nontypical clinical features.Many factors are revealed to be relevant to the lung infections,meanwhile, various drug-resistant pathogen strains are isolated.
ObjectiveTo investigate the epidemiology, etiology and prognosis of pneumonia in lung transplantation recipients. MethodsWe retrospectively analyzed the follow-up data of 42 case times (40 patients) of allogenic lung transplantation between March 2005 and August 2014. There were 29 males and 11 females with a mean age of 52.4±13.8 years. There were 32 case times with double lung transplantation, and 10 case times with single lung transplantation. Two patients underwent lung transplantation twice at an interval of 6.5 years and 4.0 years, respectively. ResultsIn 42 case times of lung transplantation, 26 case times had forty-two episodes of pneumonia throughout the follow-up period of median 146 days (range 3 to 2 704 days). Microbiological etiology was established in 36 case times of pneumonia. Bacterial pneumonia (68.1%) was more frequent than fungal (10.6%) and viral pneumonia (8.5%). The cumulative risk of a pneumonia episode increased sharply in the first 30 days after transplantation. A percentage of 38.1% of total pneumonia episodes occurred within 30 days after transplantation, predominately due to Gram negative bacilli. While pneumonia of gram-negative bacilli occurred earliest with a median of 20 days (range 8-297 days). pneumonia caused by viruses (283 days, range 186-482 days) appeared significantly later than gram-negative bacilli, and unknown etiology (44.5 days, range 3-257 days) (P=0.001 and P=0.019, respectively). The survival rate in 1 year, 3 years, and 5 years was 66.1%, 56.3%, and 36.2%, respectively. pneumonia episode within 30 days after lung transplantation was associated remarkably with mortality risk (P=0.03) in lung transplantation recipients. The total blood loss during transplantation procedure and post-transplantation intubation time were associated significantly with early onset of pneumonia (≤30 days) by univariate analysis. ConclusionRecognition of epidemiology, etiology and chronology of post-transplantaion pneumonia has implications relevant for appropriate management and optimal antibiotic prescription in lung transplantation recipients.
Objective To establish a rat model of chronic pulmonary infection by inoculating Pseudomonas aeruginosa to Sprague-Dawley(SD) rats.Metods Sixty SD rats were divided into 2 groups,ie.the P.aeruginosa group and the control group. Silicone tube precoated with P.aeruginosa was placed into the main bronchus. For the control group, sterile silicon tube was intubated. Results P ． aeruginosa was detected from lung tissue of rats in infected groups.Bacterial number was higher than 103cfu ／ g 28 days after inoculation.The pathological study showed fibrinous proliferation and granulomas formation in the lungs of infected rats 28 days after inoculation.Microscopy examination showed a inflammation predominantly with lymphocyte infiltration.In control group, no bacterial and pathological changes could be detected. Conclusions The animal model with P.aeruginosa chronic pulmonary infection can be established successfully by silicone tubes precoated with P.aeruginosa intubated into the main bronchus.
目的:探討纖維支氣管鏡(簡稱纖支鏡)肺泡灌洗術在治療肺部感染性疾病的療效。方法:共從內科系統中入選社區獲得性肺炎和醫院獲得性肺炎患者122例,將其分為二組,治療組:傳統治療加纖支鏡肺泡灌洗術治療肺部感染,共52例;對照組:傳統方法治療肺部感染,共70例。結果:兩組病例在發熱時間,咳嗽,咳痰及肺部羅音消失時間,住院日,抗生素使用時間,治愈率和死亡率方面對比均有顯著性差異(Plt;0.05)。結論:纖支鏡肺泡灌洗術在治療肺部感染性疾病的療效確切,且術中危險性小,值得推廣。
對臨床上一個擬診肺部感染的患者, 臨床醫生通常依據癥狀、白細胞總數和分類計數, 以及胸部影像學檢查作出診斷, 以期盡早開始治療, 此時抗生素的選擇只能是經驗性的, 等治療后隨訪觀察胸片上的浸潤影有無吸收才能確定此浸潤影是否為感染性的。換言之, 臨床癥狀及影像學檢查對于鑒別感染性和非感染性肺部疾病缺乏特異性, 而肺部感染的診斷多屬于回顧性的。 目前, 有一些生物標志物用于幫助判斷肺部浸潤影為感染性或非感染性, 主要包括C 反應蛋白( C-reactive protein,CRP) 、降鈣素原( procalcitonin, PCT) 和可溶性髓樣細胞觸發受體1( soluble triggering receptor expressed onmyeloid cells-1,sTREM-1) 等。
抗生素的降階梯治療（de-escalation therapy）是近年來提出的用于治療重癥肺部感染的一個策略，在臨床研究和實踐中能夠有效地提高重癥感染治療的成功率，降低病死率，同時降低住院時間和費用，是感染治療策略的一大進展。本文就這一策略的概念演變和應用時機作一介紹