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[铜绿假单胞菌引起的医院感染。在重症治疗中的意义]

[Hospital infections caused by Pseudomonas aeruginosa. Significance in intensive therapy].

作者信息

Sidorenko S V, Gel'fand E B, Mamontova O A

出版信息

Anesteziol Reanimatol. 1999 May-Jun(3):46-54.

Abstract

The significance of P. aeruginosa as an agent of hospital infections in intensive care departments is determined by high prevalence of this microorganism, its natural and acquired resistance to antibiotics of various groups, and severity of the infection it induces. The resistance of P. aeruginosa to antibiotics is different in different regions. Among the strains isolated in Moscow in intensive care wards for newborns 9% were resistant to meropenem, 10% to amicacine, 15% to imipramine, 16% to cefepime, 37% to ceftasidime, 45% to piperacylline/tasobactam, 45% to ciprofloxacine, and 60% to gentamicin; 1.5% of these strains were resistant to all tested antibiotics. High prevalence of antibiotic resistance among P. aeruginosa impedes the choice of drugs for empirical antibiotic therapy and increases the significance of microbiological diagnosis. Even if an agent is sensitive to such antibiotics as semisynthetic penicillines and aminoglycosides, their use as monotherapy in infections caused by P. aeruginosa is ineffective. Carbapenemes, III- IV generations cefalosporines, and fluoroquinolones can be used as mono therapy.

摘要

铜绿假单胞菌作为重症监护病房医院感染病原体的重要性,取决于该微生物的高流行率、其对各类抗生素的天然及获得性耐药性,以及它所引发感染的严重程度。铜绿假单胞菌对抗生素的耐药性在不同地区有所不同。在莫斯科新生儿重症监护病房分离出的菌株中,9%对美罗培南耐药,10%对阿米卡星耐药,15%对亚胺培南耐药,16%对头孢吡肟耐药,37%对头孢他啶耐药,45%对哌拉西林/他唑巴坦耐药,45%对环丙沙星耐药,60%对庆大霉素耐药;其中1.5%的菌株对所有测试抗生素均耐药。铜绿假单胞菌中抗生素耐药性的高流行率阻碍了经验性抗生素治疗药物的选择,并增加了微生物学诊断的重要性。即使某种病原体对诸如半合成青霉素和氨基糖苷类等抗生素敏感,在由铜绿假单胞菌引起的感染中单独使用这些药物作为治疗是无效的。碳青霉烯类、第三代和第四代头孢菌素类以及氟喹诺酮类可作为单一疗法使用。

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