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本文引用的文献

1
Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases.全球扩展型碳青霉烯酶肺炎克雷伯菌的临床流行病学。
Lancet Infect Dis. 2013 Sep;13(9):785-96. doi: 10.1016/S1473-3099(13)70190-7.
2
KPC - 3 Klebsiella pneumoniae ST258 clone infection in postoperative abdominal surgery patients in an intensive care setting: analysis of a case series of 30 patients.术后腹部手术患者重症监护环境中感染产碳青霉烯酶肺炎克雷伯菌 ST258 克隆（KPC-3）：30 例患者的病例系列分析。
BMC Anesthesiol. 2013 Jul 3;13(1):13. doi: 10.1186/1471-2253-13-13.
3
Trends in resistance to carbapenems and third-generation cephalosporins among clinical isolates of Klebsiella pneumoniae in the United States, 1999-2010.美国 1999-2010 年临床分离肺炎克雷伯菌对碳青霉烯类和第三代头孢菌素耐药趋势。
Infect Control Hosp Epidemiol. 2013 Mar;34(3):259-68. doi: 10.1086/669523. Epub 2013 Jan 23.
4
Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions.肺炎克雷伯菌和其他肠杆菌科细菌中的碳青霉烯酶：具有全球范围的不断演变的危机。
Clin Microbiol Rev. 2012 Oct;25(4):682-707. doi: 10.1128/CMR.05035-11.
5
Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy.产碳青霉烯酶肺炎克雷伯菌血流感染患者的死亡率预测因素：联合治疗的重要性。
Clin Infect Dis. 2012 Oct;55(7):943-50. doi: 10.1093/cid/cis588. Epub 2012 Jul 2.
6
Excess deaths associated with tigecycline after approval based on noninferiority trials.获批依据非劣效性试验后与替加环素相关的超额死亡。
Clin Infect Dis. 2012 Jun;54(12):1699-709. doi: 10.1093/cid/cis270. Epub 2012 Mar 30.
7
Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens.产 KPC 肺炎克雷伯菌血症的治疗转归：联合抗菌方案的优势。
Antimicrob Agents Chemother. 2012 Apr;56(4):2108-13. doi: 10.1128/AAC.06268-11. Epub 2012 Jan 17.
8
Two cases of monomicrobial intraabdominal abscesses due to KPC--3 Klebsiella pneumoniae ST258 clone.两例由产碳青霉烯酶肺炎克雷伯菌 ST258 克隆导致的单一微生物性腹腔脓肿。
BMC Gastroenterol. 2011 Sep 30;11:103. doi: 10.1186/1471-230X-11-103.
9
Resurgence of colistin: a review of resistance, toxicity, pharmacodynamics, and dosing.多粘菌素的复兴：耐药性、毒性、药效学和剂量的综述。
Pharmacotherapy. 2010 Dec;30(12):1279-91. doi: 10.1592/phco.30.12.1279.
10
Systematic review and meta-analysis of antibiotic prophylaxis in severe acute pancreatitis.重症急性胰腺炎抗生素预防的系统评价与荟萃分析
Scand J Gastroenterol. 2011 Mar;46(3):261-70. doi: 10.3109/00365521.2010.531486. Epub 2010 Nov 10.

多重耐药肺炎克雷伯菌性胰腺炎：严重外科感染中的新挑战。

Multi-drug-resistant Klebsiella pneumoniae pancreatitis: a new challenge in a serious surgical infection.

作者信息

Tugal Derin, Lynch Melanie, Hujer Andrea M, Rudin Susan, Perez Federico, Bonomo Robert A

机构信息

1 Department of Medicine, University Hospitals Case Medical Center , Cleveland, Ohio.

出版信息

Surg Infect (Larchmt). 2015 Apr;16(2):188-93. doi: 10.1089/sur.2012.175. Epub 2014 May 21.

DOI:10.1089/sur.2012.175
PMID:24850293
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4394169/
Abstract

BACKGROUND

Klebsiella pneumoniae is an important cause of nosocomial infections, but its role in severe acute pancreatitis (SAP) is not well defined. Few cases of K. pneumoniae associated SAP have been reported. Due to the emergence of extended-spectrum beta-lactamases (ESBLs) and carbapenemases, treatment of multidrug-resistant (MDR) K. pneumoniae presents a challenge. Tigecycline and colistin have gained recent attention for their broad-spectrum antimicrobial activity.

METHODS

We describe a case of SAP due to K. pneumoniae bearing K. pneumoniae carbapenemase (KPC) treated successfully with colistin plus tigecycline and offer a review of similar experiences published in the literature.

RESULTS

The case reported herein required surgical drainage of multiple pancreatic abscesses and treatment with tigecycline and colistin. Our comparative analysis revealed a number of unique features associated with SAP due to K. pneumoniae: 1) underlying pancreatic injury, 2) multiple drug resistance determinants and virulence factors that complicate treatment, and 3) surgical debridement as a requirement for cure.

CONCLUSION

As the prevalence of K. pneumoniae bearing KPC continues to increase in the healthcare setting, SAP caused by this MDR pathogen will become more common. Tigecycline plus colistin was a successful antibiotic regimen for the treatment of SAP due to K. pneumoniae bearing KPC.

摘要

背景

肺炎克雷伯菌是医院感染的重要病因，但其在重症急性胰腺炎（SAP）中的作用尚不明确。报道的肺炎克雷伯菌相关性SAP病例较少。由于超广谱β-内酰胺酶（ESBLs）和碳青霉烯酶的出现，耐多药（MDR）肺炎克雷伯菌的治疗面临挑战。替加环素和黏菌素因其广谱抗菌活性最近受到关注。

方法

我们描述了1例由产肺炎克雷伯菌碳青霉烯酶（KPC）的肺炎克雷伯菌引起的SAP病例，该病例通过黏菌素联合替加环素治疗成功，并对文献中发表的类似经验进行了综述。

结果

本文报道的病例需要对多个胰腺脓肿进行手术引流，并使用替加环素和黏菌素治疗。我们的比较分析揭示了一些与肺炎克雷伯菌所致SAP相关的独特特征：1）潜在的胰腺损伤；2）多种耐药决定因素和毒力因子使治疗复杂化；3）手术清创是治愈的必要条件。

结论

随着产KPC肺炎克雷伯菌在医疗环境中的患病率持续上升，这种耐多药病原体引起的SAP将变得更加常见。替加环素联合黏菌素是治疗产KPC肺炎克雷伯菌所致SAP的一种成功的抗生素方案。