Clincal Management of Pseudmonas Aeruginasa Pulmonary Infection：Difficulties，Insuffciency，and Excrss_Chinese Journal of Respiratory and Critical Care Medicine

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YANG Jin ¹ , QU Jieming ²

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Keywords：

銅綠假單胞菌; 肺部感染; ; 臨床處理

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銅綠假單胞菌( Pseudomonas aeruginosa) 屬于非發酵類假單胞菌, 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70 年代, 銅綠假單胞菌僅被認為是導致粒細胞缺乏患者發生致死性菌血癥的病原體, 而到上世紀末及本世紀初, 銅綠假單胞菌已是醫院獲得性感染的主要病原體[ 1] 。在皮膚黏膜發生破壞( 如氣管插管、燒傷、機械通氣) , 免疫功能低下( 如中性粒細胞缺乏、細胞免疫功能缺陷) , 以及菌群失調的患者, 銅綠假單胞菌感染的發生率相當高。汪復等[ 2] 對國內主要地區的12所教學醫院臨床分離細菌資料的統計發現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, 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, 給臨床治療銅綠假單胞菌感染帶來了更大的挑戰。本文主要對目前臨床上銅綠假單胞菌肺部感染
治療中的難點及臨床處理的過度與不足進行闡述。

Citation： YANG Jin,QU Jieming. Clincal Management of Pseudmonas Aeruginasa Pulmonary Infection：Difficulties，Insuffciency，and Excrss. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(6): 555-556. doi: Copy

1.	Kipnis E, Sawa T, Wiener-Kronish J. Targeting mechanisms of Pseudomonas aeruginosa pathogenesis. Med Mal Infect, 2006, 36 :78-91.
2.	汪復, 朱德妹, 胡付品, 等. 2008 年中國CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2009, 9 : 321-329.
3.	倪語星. 2005 年中國CHINET 銅綠假單胞菌耐藥性分析. 中國感染與化療雜志, 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測. 中國感染與化療雜志, 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. 細菌生物被膜與難治性呼吸道感染. 中國感染與化療雜志, 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. 大環內酯類藥物對銅綠假單胞菌生物膜形成的影響. 中國抗生素雜志, 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. Kipnis E, Sawa T, Wiener-Kronish J. Targeting mechanisms of Pseudomonas aeruginosa pathogenesis. Med Mal Infect, 2006, 36 :78-91.
2. 汪復, 朱德妹, 胡付品, 等. 2008 年中國CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2009, 9 : 321-329.
3. 倪語星. 2005 年中國CHINET 銅綠假單胞菌耐藥性分析. 中國感染與化療雜志, 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測. 中國感染與化療雜志, 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. 細菌生物被膜與難治性呼吸道感染. 中國感染與化療雜志, 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. 大環內酯類藥物對銅綠假單胞菌生物膜形成的影響. 中國抗生素雜志, 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 .

Chinese Journal of Respiratory and Critical Care Medicine

Clincal Management of Pseudmonas Aeruginasa Pulmonary Infection：Difficulties，Insuffciency，and Excrss

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