Kozioł-Montewka Maria, Jaworska-Gromaszek Iwona, Biernacka Jadwiga, Pluta Aneta, Niedźwiadek Justyna, Kaczor Danuta, Ligięza Jerzy, Rudzki Sławomir
Department of Microbiology, Medical University of Lublin.
Anestezjol Intens Ter. 2011 Jul-Sep;43(3):163-8.
Ventilator-associated pneumonia (VAP) occurs in approximately 10-20% of mechanically ventilated patients, and is associated with an extremely high mortality rate (up to 70%). The purpose of the study was to determine the susceptibility spectrum of Klebsiella, Pseudomonas and Acinetobacter strains isolated from VAP patients.
We analysed 81 strains of microorganisms isolated from bronchoalveolar lavages (BAL) of VAP patients. The minimal inhibitory concentrations (MIC) of antibiotics recommended for empirical therapy were determined using an automated VITEK 2 system, and for the MIC of doripenem - the Etest assay. Results were analysed following the guidelines of the Clinical and Laboratory Standards Institute.
For infections caused by the group of bacteria under investigation, the most successful regimen was monotherapy with carbapenems (doripenem, meropenem and imipenem). Cephalosporins (cefepim and ceftazidim) were less effective in vitro. The worst results were obtained with the combination of piperacillin/tazobactam with aminoglycosides (amikacin or gentamicin) or fluoroquinolones (ciprofloxacin).
Antibiotic monotherapy proved to be more effective in VAP patients than combined therapy; the best results were achieved with carbapenems. Doripenem showed strong activity in vitro against P. aeruginosa and Klebsiella sp. and should be considered for empirical VAP therapy; however, carbapenems may be less effective against Acinetobacter baumannii. The wide range of bacteria, and their broad range of susceptibility to antibiotics, suggests the need for modification of current recommendations.
呼吸机相关性肺炎（VAP）发生在约10%-20%的机械通气患者中，且死亡率极高（高达70%）。本研究的目的是确定从VAP患者中分离出的克雷伯菌属、假单胞菌属和不动杆菌属菌株的药敏谱。
我们分析了从VAP患者支气管肺泡灌洗（BAL）中分离出的81株微生物。使用自动VITEK 2系统测定经验性治疗推荐抗生素的最低抑菌浓度（MIC），对于多利培南的MIC采用Etest法测定。按照临床和实验室标准协会的指南分析结果。
对于由所研究的细菌组引起的感染，最有效的治疗方案是碳青霉烯类（多利培南、美罗培南和亚胺培南）单药治疗。头孢菌素（头孢吡肟和头孢他啶）在体外效果较差。哌拉西林/他唑巴坦与氨基糖苷类（阿米卡星或庆大霉素）或氟喹诺酮类（环丙沙星）联合使用效果最差。
抗生素单药治疗在VAP患者中被证明比联合治疗更有效；碳青霉烯类取得了最佳效果。多利培南在体外对铜绿假单胞菌和克雷伯菌属表现出强大活性，应考虑用于VAP经验性治疗；然而，碳青霉烯类对鲍曼不动杆菌可能效果较差。细菌种类繁多，且它们对抗生素的敏感性范围广泛，这表明需要修改当前的推荐方案。
