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目的探讨人感染高致病性禽流感继发多耐药铜绿假单胞菌(MDRP)肺部感染的治疗方法。方法2006年6月,对1例高致病性H5N1亚型禽流感并急性呼吸窘迫综合征(ARDS)青年男性患者进行机械通气治疗,随后出现MDRP的肺部感染;病原学药敏结果显示,该株MDRP仅对多黏菌素B和E等少量抗菌药物敏感;遂予以多黏菌素B每日40～100mg分2次肌肉或静脉注射,并多黏菌素E每日30～50万u分3～4次雾化吸入,使用剂量根据痰菌半定量检测结果进行调整。结果多黏菌素B全身用药累积疗程33d,累积剂量1760mg;多黏菌素E雾化吸入累积疗程36d,累积剂量1485万u;患者肺部感染得到有效控制;多黏菌素治疗MDRP有效且不良反应较轻,其治疗终点的判断需根据临床和实验室资料进行全面评估。结论多黏菌素能有效治疗禽流感患者继发MDRP的感染。
Objective To investigate the treatment of pulmonary infection of multi-drug resistant Pseudomonas aeruginosa (MDRP) in humans infected with HPAI. Methods In June 2006, one male patient with highly pathogenic H5N1 subtype of avian influenza Acute Respiratory Distress Syndrome (ARDS) was treated with mechanical ventilation, followed by pulmonary infection of MDRP. The etiological susceptibility results showed that, The strain MDRP sensitive only to a small amount of antibiotics such as polymyxin B and E; then to polymyxin B daily 40 ~ 100mg points 2 times by muscle or intravenous injection, and polymyxin E daily 300,000 to 500,000 u points 3 to 4 times inhalation atomization, the use of dose according to the results of semi-quantitative detection of sputum to be adjusted. Results The cumulative course of polymyxin B systemic administration was 33 days, with a cumulative dose of 1760 mg. Polymyxin E inhalation cumulative treatment was 36 days, with a cumulative dose of 14.85 million u. Pulmonary infection was effectively controlled. Polymyxin treatment of MDRP was effective Less adverse reactions, the judgment of the end of treatment based on clinical and laboratory data to conduct a comprehensive assessment. Conclusion Polymyxin can effectively treat secondary MDRP infection in bird flu patients.