Liu Xinglou, Zhou Hua, Shu Sainan, Li Ge, Fang Feng
Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Palliat Med. 2023 Jan;12(1):193-199. doi: 10.21037/apm-22-900. Epub 2022 Nov 14.
Acinetobacter baumannii (A. baumannii) is one of the most common pathogens that cause hospital-acquired infections. In recent years, drug-resistant A. baumannii has become prevalent worldwide, and pandrug-resistant A. baumannii is increasingly being observed. However, treating pandrug-resistant A. baumannii is very difficult.
We report a case of an 8-year-old girl with severe pandrug-resistant A. baumannii pneumonia complicated with a diaphragmatic hernia. The patient arrived at Tongji Hospital with a fever and cough, and she was admitted to the pediatric intensive care unit with pneumonia. The day after admission, her condition worsened. She had breathing difficulties and loss of consciousness, and a ventilator was used immediately. On the fourth day after being on the ventilator, the sputum culture was positive for A. baumannii. Initially, multiple antibiotic sensitivity tests showed resistance to all antibiotics. This suggested that using antibiotics would be ineffective. After the use of all antibiotics was discontinued for 8 days, susceptibility testing of tigecycline indicated intermediate susceptibility. Following the initiation of tigecycline treatments for 5 weeks, the bacterial infection was progressively controlled, the diaphragmatic hernia disappeared, and the patient gradually recovered.
Antibiotic sensitivity to pandrug-resistant A. baumannii can be restored by discontinuation of antibiotics. Antibiotics should be administrated even if the antibiotic sensitivity test shows an intermediary result. For pandrug-resistant A. baumannii, a prolonged monotherapy with a large dose of intermediary tigecycline can achieve good efficacy. In addition, the complication of a diaphragmatic hernia can return to normal after treatment with effective antibiotics, and patients may not necessarily need surgery.
鲍曼不动杆菌是引起医院获得性感染的最常见病原体之一。近年来，耐药鲍曼不动杆菌在全球范围内普遍流行，泛耐药鲍曼不动杆菌也日益常见。然而，治疗泛耐药鲍曼不动杆菌非常困难。
我们报告一例8岁女童，患有严重的泛耐药鲍曼不动杆菌肺炎并伴有膈疝。该患者因发热和咳嗽入住同济医院，因肺炎被收入儿科重症监护病房。入院次日，病情恶化。她出现呼吸困难和意识丧失，立即使用了呼吸机。使用呼吸机后的第四天，痰培养鲍曼不动杆菌呈阳性。最初，多次抗生素敏感性试验显示对所有抗生素均耐药。这表明使用抗生素将无效。在停用所有抗生素8天后，替加环素的药敏试验显示为中度敏感。在开始使用替加环素治疗5周后，细菌感染逐渐得到控制，膈疝消失，患者逐渐康复。
停用抗生素可恢复泛耐药鲍曼不动杆菌的抗生素敏感性。即使抗生素敏感性试验显示为中介结果，也应使用抗生素。对于泛耐药鲍曼不动杆菌，大剂量替加环素延长单药治疗可取得良好疗效。此外，膈疝并发症在有效抗生素治疗后可恢复正常，患者不一定需要手术。
