• 1 安徽醫(yī)科大學(xué)第二附屬醫(yī)院呼吸內(nèi)科( 安徽合肥 230601);;
  • 2 復(fù)旦大學(xué)附屬華東醫(yī)院呼吸內(nèi)科( 上海 200040)通訊作者: 瞿介明, E-mail: jmqu64@ yahoo. com. cn;

銅綠假單胞菌( Pseudomonas aeruginosa) 屬于非發(fā)酵類假單胞菌, 廣泛存在于自然界中, 也可廣泛定植于人體消化道、呼吸道、皮膚及泌尿道等部位。20 世紀(jì)70 年代, 銅綠假單胞菌僅被認(rèn)為是導(dǎo)致粒細(xì)胞缺乏患者發(fā)生致死性菌血癥的病原體, 而到上世紀(jì)末及本世紀(jì)初, 銅綠假單胞菌已是醫(yī)院獲得性感染的主要病原體[ 1] 。在皮膚黏膜發(fā)生破壞( 如氣管插管、燒傷、機(jī)械通氣) , 免疫功能低下( 如中性粒細(xì)胞缺乏、細(xì)胞免疫功能缺陷) , 以及菌群失調(diào)的患者, 銅綠假單胞菌感染的發(fā)生率相當(dāng)高。汪復(fù)等[ 2] 對(duì)國(guó)內(nèi)主要地區(qū)的12所教學(xué)醫(yī)院臨床分離細(xì)菌資料的統(tǒng)計(jì)發(fā)現(xiàn)在所分離的革蘭陰性菌中銅綠假單胞菌占16. 4% , 僅次于大腸埃希菌。在銅綠假單胞菌臨床感染率不斷增加的同時(shí), 銅綠假單胞菌耐
藥率逐漸增加, 特別是耐多藥( MDR) 或者泛耐藥( PDR) 銅綠假單胞菌的出現(xiàn), 給臨床治療銅綠假單胞菌感染帶來(lái)了更大的挑戰(zhàn)。本文主要對(duì)目前臨床上銅綠假單胞菌肺部感染
治療中的難點(diǎn)及臨床處理的過(guò)度與不足進(jìn)行闡述。

引用本文： 楊進(jìn),瞿介明. 銅綠假單胞菌肺部感染: 難點(diǎn)及臨床處理的不足與過(guò)度. 中國(guó)呼吸與危重監(jiān)護(hù)雜志, 2010, 9(6): 555-556. doi: 復(fù)制

1. Kipnis E, Sawa T, Wiener-Kronish J. Targeting mechanisms of Pseudomonas aeruginosa pathogenesis. Med Mal Infect, 2006, 36 :78-91.
2. 汪復(fù), 朱德妹, 胡付品, 等. 2008 年中國(guó)CHINET 細(xì)菌耐藥性監(jiān)測(cè). 中國(guó)感染與化療雜志, 2009, 9 : 321-329.
3. 倪語(yǔ)星. 2005 年中國(guó)CHINET 銅綠假單胞菌耐藥性分析. 中國(guó)感染與化療雜志, 2007, 7 : 274-278.
4. 周慶濤, 姚婉貞, 陳亞紅, 等. 2001 ～2005 年呼吸科病房臨床分離菌的變遷及耐藥性分析監(jiān)測(cè). 中國(guó)感染與化療雜志, 2007, 7 :53-57.
5. Carmeli Y, Troillet N, Eliopoulos GM, et al. Emergence of antibiotic -resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother, 1999, 43: 1379-1382.
6. Rossolini GM, Mantengoli E. Treatment and control of severe infections caused by multiresistant Pseudomonas aeruginosa. Clin Microbiol Infect, 2005 , 11( Suppl 4) : 17 -32 .
7. Livermore DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis,2002, 34: 634-640 .
8. Chamot E, Boffi El Amari E, Rohner P, et al. Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother, 2003, 47: 2756-2764.
9. American Thoracic Society; Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416 .
10. 李鴻雁, 夏前明. 細(xì)菌生物被膜與難治性呼吸道感染. 中國(guó)感染與化療雜志, 2004 , 4: 190-192 .
11. Wozniak DJ, Keyser R. Effects of subinhibitory concentrations of macrolide antibiotics on Pseudomonas aeruginosa. Chest, 2004, 125 ( 2 Suppl) : 62S-69S.
12. Hassett DJ, Korfhagen TR, Irvin RT, et al. Pseudomonas aeruginosa biofilm infections in cystic fibrosis: insights into pathogenic processes and treatment strategies. Expert Opin Ther Targets, 2010 ,14: 117-130 .
13. 彭程, 肖永紅. 大環(huán)內(nèi)酯類藥物對(duì)銅綠假單胞菌生物膜形成的影響. 中國(guó)抗生素雜志, 2001, 26 : 286-289 .
14. Lodise TP Jr, Patel N, Kwa A, et al. Predictors of 30-day mortality among patients with Pseudomonas aeruginosa bloodstream infections: impact of delayed appropriate antibiotic selection.Antimicrob Agents Chemother, 2007, 51 : 3510 -3515 .
  1. 1. Kipnis E, Sawa T, Wiener-Kronish J. Targeting mechanisms of Pseudomonas aeruginosa pathogenesis. Med Mal Infect, 2006, 36 :78-91.
  2. 2. 汪復(fù), 朱德妹, 胡付品, 等. 2008 年中國(guó)CHINET 細(xì)菌耐藥性監(jiān)測(cè). 中國(guó)感染與化療雜志, 2009, 9 : 321-329.
  3. 3. 倪語(yǔ)星. 2005 年中國(guó)CHINET 銅綠假單胞菌耐藥性分析. 中國(guó)感染與化療雜志, 2007, 7 : 274-278.
  4. 4. 周慶濤, 姚婉貞, 陳亞紅, 等. 2001 ～2005 年呼吸科病房臨床分離菌的變遷及耐藥性分析監(jiān)測(cè). 中國(guó)感染與化療雜志, 2007, 7 :53-57.
  5. 5. Carmeli Y, Troillet N, Eliopoulos GM, et al. Emergence of antibiotic -resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrob Agents Chemother, 1999, 43: 1379-1382.
  6. 6. Rossolini GM, Mantengoli E. Treatment and control of severe infections caused by multiresistant Pseudomonas aeruginosa. Clin Microbiol Infect, 2005 , 11( Suppl 4) : 17 -32 .
  7. 7. Livermore DM. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin Infect Dis,2002, 34: 634-640 .
  8. 8. Chamot E, Boffi El Amari E, Rohner P, et al. Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrob Agents Chemother, 2003, 47: 2756-2764.
  9. 9. American Thoracic Society; Infectious Diseases Society of America.Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171: 388-416 .
  10. 10. 李鴻雁, 夏前明. 細(xì)菌生物被膜與難治性呼吸道感染. 中國(guó)感染與化療雜志, 2004 , 4: 190-192 .
  11. 11. Wozniak DJ, Keyser R. Effects of subinhibitory concentrations of macrolide antibiotics on Pseudomonas aeruginosa. Chest, 2004, 125 ( 2 Suppl) : 62S-69S.
  12. 12. Hassett DJ, Korfhagen TR, Irvin RT, et al. Pseudomonas aeruginosa biofilm infections in cystic fibrosis: insights into pathogenic processes and treatment strategies. Expert Opin Ther Targets, 2010 ,14: 117-130 .
  13. 13. 彭程, 肖永紅. 大環(huán)內(nèi)酯類藥物對(duì)銅綠假單胞菌生物膜形成的影響. 中國(guó)抗生素雜志, 2001, 26 : 286-289 .
  14. 14. Lodise TP Jr, Patel N, Kwa A, et al. Predictors of 30-day mortality among patients with Pseudomonas aeruginosa bloodstream infections: impact of delayed appropriate antibiotic selection.Antimicrob Agents Chemother, 2007, 51 : 3510 -3515 .