Zhang Hong-min, Liu Da-Wei, Wang Xiao-ting, Long Yun, Chen Huan
Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
Chin Med Sci J. 2014 Mar;29(1):51-4. doi: 10.1016/s1001-9294(14)60025-0.
IN the presence of septic shock, every hour in delaying the administration of effective antibiotics is associated with a measurable increase in mortality. This is especially true for neutropenic patients with septic shock.1 As there is a higher incidence of involving multi-drug resistant pathogens for neutropenic patients, the decision on antibiotics regime remains a challenge for physicians.2 Immunosuppression and previous antibacterial use are factors that promote the spread of multi-drug resistant pathogens, and the possibility of co-existing multi-drug resistant pathogens should be suspected when treating patients with these risk factors who developed refractory shock. Here we present a case with neutropenic fever and refractory shock whose blood culture yielded multi-drug resistant Acinetobacter baumannii and carbapenem- resistant Klebsiella pneumoniae.
在脓毒性休克的情况下，每延迟一小时给予有效的抗生素，死亡率就会有明显上升。对于患有脓毒性休克的中性粒细胞减少患者来说尤其如此。1由于中性粒细胞减少患者感染多重耐药病原体的发生率较高，因此抗生素治疗方案的决策对医生来说仍然是一项挑战。2免疫抑制和先前使用抗菌药物是促进多重耐药病原体传播的因素，在治疗有这些危险因素且发生难治性休克的患者时，应怀疑存在多重耐药病原体共存的可能性。在此，我们报告一例中性粒细胞减少性发热和难治性休克病例，其血培养结果显示为多重耐药鲍曼不动杆菌和耐碳青霉烯肺炎克雷伯菌。
