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铜绿假单胞菌作为骨髓炎的主要致病因子及其对抗生素的敏感性。

Pseudomonas Aeruginosa as the Main Causative Agent of Osteomyelitis and its Susceptibility to Antibiotics.

机构信息

Research Institute of Traumatology and Orthopedics, Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan.

出版信息

Drug Res (Stuttg). 2020 Jun;70(6):280-285. doi: 10.1055/a-1150-2372. Epub 2020 Apr 17.

Abstract

Surgical activity is increasing in the treatment of many types of fractures, the use of various metal structures, and the potential for infection with the development of osteomyelitis accordingly increases. The urgency of the problem is due to the fact that this disease is the most expensive medical problem, especially when it comes to prosthetics of large joints, with socially significant losses and the occurrence of disability in patients of working age, it requires long-term treatment. The aim of this study was to study one of the most complex pathogens of life-threatening infections due to its high virulence and ability to adapt to changing environmental conditions, in particular the action of antibacterial drugs and the study of its sensitivity to certain groups of antimicrobial drugs. The results of the study showed that over the three years of observation in 2017-2019, the average value of Pseudomonas aeruginosa in the amount of 10.8% was established in the etiology of osteomyelitis. The revealed sensitivity of Pseudomonas aeruginosa is preserved to fluoroquinolone - levofloxanin, aminoglycosides-amikacin, gentamicin, carbapenems - meropenem, doripenem. All of the above drugs can be used as empirical therapy. During this period, a significant decrease in sensitivity was found, which reached in 2019 for cefepime - 51.9%, pefloxacin - 55.8%, ertapenem - 59.7%. The success of the treatment of this pathology directly depends on the timely microbiological diagnosis and the choice of patient treatment tactics with the appointment of effective antibacterial therapy, with an adequate exposure of antibiotic.

摘要

手术活动在治疗多种类型的骨折、使用各种金属结构方面不断增加,因此,骨髓炎的感染风险也相应增加。这个问题之所以紧迫,是因为这种疾病是最昂贵的医疗问题,尤其是涉及到大关节假体时,会带来重大的社会损失和患者丧失工作能力,需要长期治疗。本研究的目的是研究一种最复杂的病原体之一,由于其高毒性和适应不断变化的环境条件的能力,尤其是对抗菌药物的作用及其对某些类别的抗菌药物的敏感性研究,这种病原体可导致危及生命的感染。研究结果表明,在 2017 年至 2019 年的三年观察期间,发现 10.8%的铜绿假单胞菌在骨髓炎病因学中平均存在。铜绿假单胞菌的发现敏感性保持不变,对氟喹诺酮类-左氧氟沙星、氨基糖苷类-阿米卡星、庆大霉素、碳青霉烯类-美罗培南、多尼培南敏感。所有上述药物均可作为经验性治疗。在此期间,发现敏感性显著下降,在 2019 年,头孢吡肟的敏感性下降至 51.9%,培氟沙星的敏感性下降至 55.8%,厄他培南的敏感性下降至 59.7%。这种病理的治疗成功直接取决于及时的微生物学诊断和根据患者的治疗策略选择,同时给予有效的抗菌治疗,并充分暴露于抗生素。

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