• 首都醫(yī)科大學(xué)附屬北京朝陽醫(yī)院北京市呼吸疾病研究所感染和臨床微生物科(北京100020);

銅綠假單胞菌、鮑曼不動桿菌和肺炎克雷伯菌是最容易產(chǎn)生對多種抗生素耐藥的院內(nèi)致病菌。耐甲氧西林金黃色葡萄球菌(MRSA)和耐萬古霉素腸球菌(VRE)的定義相對簡單，只要對一種有代表性的抗生素產(chǎn)生耐藥就可以了。但是，給多藥耐藥或者泛耐藥的革蘭陰性桿菌下定義則較為困難 ]。一般來講，如果對下列5種抗生素中兩種以上耐藥稱為多藥耐藥：包括對銅綠假單胞菌有活性的頭孢菌素類、碳青霉烯類、加酶抑制劑的B一內(nèi)酰胺類；對銅綠假單胞菌有活性的氟喹諾酮類、氨基糖苷類。如果僅對多黏菌素敏感，但是對目前所有的抗生素都耐藥則稱為泛耐藥(Pandrug—resistant)。一方面，多藥耐藥或泛耐藥的革蘭陰性菌感染逐漸增多；另一方面，許多大的制藥企業(yè)逐漸放棄了新抗生素的研發(fā)，尤其是針對革蘭陰性菌的抗生素研發(fā)更少。人們驚呼：后抗生素時代(post—antibiotic era)真的來臨了嗎 7我們?nèi)绾螒?yīng)對?

引用本文： 曹彬. 多藥耐藥革蘭陰性菌肺炎的抗感染治療. 中國呼吸與危重監(jiān)護(hù)雜志, 2008, 08(1): 3-5. doi: 復(fù)制

1. Paterson DL．The epidemiological profile of infections with muhidrug--resistant Pseudomonas aeruginosa and Acineto-- bacter species．Clin Infect Dis，2006。43(Suppl 2)：$43- S48.
2. 1 Sobieszczyk ME，F(xiàn)uruya EY，Hay CM ，et a1．Combination therapy with polymyxin B for the treatment of muhidrug·-re·- sistan t Gram -negative respiratory tract infections．J Antimi— crob Chemother，2004，54：566-569.
3. Falagas ME，Bliziotis IA．Pandrug-resistan t Gram—negative bacteria：the dawn of the post—antibiotic era?Int J Antimi— crob Agents，2007，29：630-636.
4. Rahal JJ．Novel antibiotic combinations against infections with almost completely resistant Pseudomonas aeFuginosa and Acinetobacter species．Clin Infect Dis，2006，43(Suppl 2)：$95一$99.
5. Bratu S，Tolaney P，Karumudi U，et a1．Carbapenemase—pro— ducing Klebsiella pneumoniae in Brooklyn，NY：molecular epidemiology an d in vitro activity of polymyxin B and other agents．J Antimicrob Chemother，2005，56：128—132.
6. Dubois V，Arpin C，Melon M，et a1．Nosocomial outbreak due to a multiresistant strain of Pseudomonas aeruginosa P12：eficacy of cefepime—amikacin therapy an d analysis of beta—lactam resistance．J Clin Microbiol，2001，39：2072— 2078.
7. Levin AS，Barone AA，Pen~o J，et a1．Intravenous colistin as therapy for nosocomial infections caused by muhidrug·-re-- sistant Pseudomonas aeruginosa and Acinetobacter bauman— nii．Clin Infect Dis，1999，28：1008—1011.
8. Garnacho—Montero J．Ortiz—Leyba C，Jimrnez-Jimrnez FJ，et a1．Treatment of multidrug-resistant Acinetobacter baumannii ventilator—associated pneumonia(VAP)with intravenous colistin：a comparison with imipenem—susceptible VAP．Clin Infect Dis，2003，36：1111-l118.
9. Linden PK，Kusne S，Coley K。et a1．Use of parenteral colis— tin for the treatment of serious infection due to antimicrobi— al-resistan t Pseudomonas aeFuginosa．Clin Infect Dis，2003， 37：e154-el60. 9 Markou N，Apostolakos H ，Koumoudiou C，et a1．In~avenous colistin in the treatment of sepsis from multiresistant Gram. negative bacilli in critically ill patients．Crit Care，2003，7： R78一R83.
10. Kasiakou SK，Michalopoulos A，Soteriades ES，et a1．Combination therapy with intravenous colistin for management of infections due to multidrug·-resistant Gram·-negative bacteria in patients wi thout cystic fibrosis．Antimicrob Agents Chemo 山er，2005，49：3136-3146.
11. Michalopoulos A，Kasiakou SK，Mastora Z，et a1．Aerosolized colistin for the treatment of nosocomial pneumonia due to muhidrug--resistant Gram--negative bacteria in patients without cystic fibrosis．Crit Care，2005，9：R53一R59.
12. Landman D，Bratu S，Alam M ，et a1．Citywide emergence of Pseudomonas aeruginosa strains with reduced susceptibility to polymyxin B．J Antimicrob Chemother，2005．55：954— 957.
13. Souli M ，Kontopidou FV，Koratzanis E，et a1．In vitro activity of tigecycline against multiple-drug-resistant，including pan— resistant，gram -negative and gram—positive clinical isolates from Greek hospitals．Antimicrob Agents Chemother，2006， 50：3166-3169.
14. Taccone FS，Rodriguez—Villalobos H ，De Backer D，et a1. Successful treatment of septic shock due to pan—resistan t Acinetobacter baumannii using combined antimicrobial therapy including tigecycline．Eur J Clin Microbiol Infect Dis， 2006，25：257-260.
15. Jones RN，Huynh HK，Biedenbach DJ．Activities of doripen— em(S-466 1)against drug—resistant clinical pathogens．Antimicrob Agents Chemother，2O04，48：3136—3140．.
  1. 1. Paterson DL．The epidemiological profile of infections with muhidrug--resistant Pseudomonas aeruginosa and Acineto-- bacter species．Clin Infect Dis，2006。43(Suppl 2)：$43- S48.
  2. 2. 1 Sobieszczyk ME，F(xiàn)uruya EY，Hay CM ，et a1．Combination therapy with polymyxin B for the treatment of muhidrug·-re·- sistan t Gram -negative respiratory tract infections．J Antimi— crob Chemother，2004，54：566-569.
  3. 3. Falagas ME，Bliziotis IA．Pandrug-resistan t Gram—negative bacteria：the dawn of the post—antibiotic era?Int J Antimi— crob Agents，2007，29：630-636.
  4. 4. Rahal JJ．Novel antibiotic combinations against infections with almost completely resistant Pseudomonas aeFuginosa and Acinetobacter species．Clin Infect Dis，2006，43(Suppl 2)：$95一$99.
  5. 5. Bratu S，Tolaney P，Karumudi U，et a1．Carbapenemase—pro— ducing Klebsiella pneumoniae in Brooklyn，NY：molecular epidemiology an d in vitro activity of polymyxin B and other agents．J Antimicrob Chemother，2005，56：128—132.
  6. 6. Dubois V，Arpin C，Melon M，et a1．Nosocomial outbreak due to a multiresistant strain of Pseudomonas aeruginosa P12：eficacy of cefepime—amikacin therapy an d analysis of beta—lactam resistance．J Clin Microbiol，2001，39：2072— 2078.
  7. 7. Levin AS，Barone AA，Pen~o J，et a1．Intravenous colistin as therapy for nosocomial infections caused by muhidrug·-re-- sistant Pseudomonas aeruginosa and Acinetobacter bauman— nii．Clin Infect Dis，1999，28：1008—1011.
  8. 8. Garnacho—Montero J．Ortiz—Leyba C，Jimrnez-Jimrnez FJ，et a1．Treatment of multidrug-resistant Acinetobacter baumannii ventilator—associated pneumonia(VAP)with intravenous colistin：a comparison with imipenem—susceptible VAP．Clin Infect Dis，2003，36：1111-l118.
  9. 9. Linden PK，Kusne S，Coley K。et a1．Use of parenteral colis— tin for the treatment of serious infection due to antimicrobi— al-resistan t Pseudomonas aeFuginosa．Clin Infect Dis，2003， 37：e154-el60. 9 Markou N，Apostolakos H ，Koumoudiou C，et a1．In~avenous colistin in the treatment of sepsis from multiresistant Gram. negative bacilli in critically ill patients．Crit Care，2003，7： R78一R83.
  10. 10. Kasiakou SK，Michalopoulos A，Soteriades ES，et a1．Combination therapy with intravenous colistin for management of infections due to multidrug·-resistant Gram·-negative bacteria in patients wi thout cystic fibrosis．Antimicrob Agents Chemo 山er，2005，49：3136-3146.
  11. 11. Michalopoulos A，Kasiakou SK，Mastora Z，et a1．Aerosolized colistin for the treatment of nosocomial pneumonia due to muhidrug--resistant Gram--negative bacteria in patients without cystic fibrosis．Crit Care，2005，9：R53一R59.
  12. 12. Landman D，Bratu S，Alam M ，et a1．Citywide emergence of Pseudomonas aeruginosa strains with reduced susceptibility to polymyxin B．J Antimicrob Chemother，2005．55：954— 957.
  13. 13. Souli M ，Kontopidou FV，Koratzanis E，et a1．In vitro activity of tigecycline against multiple-drug-resistant，including pan— resistant，gram -negative and gram—positive clinical isolates from Greek hospitals．Antimicrob Agents Chemother，2006， 50：3166-3169.
  14. 14. Taccone FS，Rodriguez—Villalobos H ，De Backer D，et a1. Successful treatment of septic shock due to pan—resistan t Acinetobacter baumannii using combined antimicrobial therapy including tigecycline．Eur J Clin Microbiol Infect Dis， 2006，25：257-260.
  15. 15. Jones RN，Huynh HK，Biedenbach DJ．Activities of doripen— em(S-466 1)against drug—resistant clinical pathogens．Antimicrob Agents Chemother，2O04，48：3136—3140．.

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