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在ECMO支持期间,血液中感染的患者应该接受哪种抗菌药物治疗?
Nicolas Massart1,2, Sofia Ortuno3, Charles Vidal4
1Service de Réanimation, CH de Saint-Brieuc, Saint-Brieuc, France. nicolasmassart@hotmail.fr.
概括
肠球菌种类是血液感染 (BSI) 的常见原因,患者在体外膜氧化 (ECMO). 有效的治疗需要广泛的抗生素,如皮佩拉西林/塔扎巴克坦或加巴因与万科米辛结合.
科学领域:
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
- 微生物学 微生物学
背景情况:
- 血流感染 (BSI) 是需要体外膜氧化 (ECMO) 支持的患者的重大并发症.
- 了解这种脆弱人群中BSI的流行病学和抗菌感受性模式对于有效管理至关重要.
研究的目的:
- 描述血液感染 (BSI) 的流行病学在接受体外膜氧化 (ECMO) 支持的大量患者中.
- 在ECMO患者中评估导致BSI的微生物的抗微生物敏感性.
- 评估这种人群中BSI的实证抗菌疗法的适当性.
主要方法:
- 在12个欧洲重症监护病房 (ICU) 进行的回顾性观察研究.
- 纳入标准:在ECMO支持期间,患有来源不明的BSI的患者.
- 收集了有关人口统计,ECMO适应症,致病微生物和抗微生物治疗的数据.
主要成果:
- 包括182名患者;常见的ECMO适应症是ARDS,心脏性休克和心脏切除术后.
- 肠球菌 (37.4%) 是最常见的BSI病因,其次是肠球菌 (26.9%).
- 多重耐药生物 (MDROs) 占BSI的14.3%. 在71.4%的病例中,获得了适当的抗菌疗法,比比佩拉西林/塔扎巴克坦或与万科米结合的卡巴胺的比例更高.
结论:
- 菌种在ECMO患者中是导致BSI的主要原因.
- 第三代头类的敏感率很低.
- 皮佩拉西林/塔扎巴克坦或卡巴胺,与万科米辛结合,在ECMO患者中代表BSI的有效治疗选择.
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