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婴儿肝移植术后产金属β-内酰胺酶肺炎克雷伯菌腹腔感染治疗1

例及文献复习 Δ

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刘东华 ，郭延磊 ，曲海军 ，周长凯 ，全香花 ，崔萌纳 ，李 静 （1.青岛大学附属医院药学部，山东 青岛
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266000；2.青岛市即墨区田横岛省级旅游度假区卫生院，山东 即墨 266209）
中图分类号 R978.1；R619 .3 文献标志码 A 文章编号 1001-0408（2022）11-1397-06
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DOI 10.6039/j.issn.1001-0408.2022.11.20
摘 要 目的 探讨儿童实体器官移植受者耐氨曲南的产金属β-内酰胺酶（MBL）肠杆菌科细菌感染的治疗方案。方法 回顾分析
1例婴儿肝移植术后耐氨曲南的产MBL肺炎克雷伯菌致腹腔感染的临床资料。患儿术后发生腹腔感染，致病菌为产MBL肺炎克
雷伯菌，药敏结果提示对氨曲南耐药。初始方案基于药敏结果选用了多黏菌素B联合替加环素的方案，治疗效果不佳，同时出现
病情反复和休克性花斑。临床药师协助临床医师制定头孢他啶阿维巴坦 0.5 g，q8 h联合氨曲南0.18 g，q6 h的治疗方案；同时复
习国内外相关文献，总结实体器官移植术后产MBL肠杆菌科细菌感染的治疗方案。结果与结论 该患儿最终使用头孢他啶阿维
巴坦联合氨曲南成功治愈出院。多篇国外文献报道头孢他啶阿维巴坦联合氨曲南可以有效治疗器官移植患者因耐氨曲南的产
MBL肠杆菌科细菌导致的感染，该方案有望成为儿童实体器官移植受者该耐药菌感染的有效治疗方案。
关键词 头孢他啶阿维巴坦；氨曲南；儿童；腹腔感染；器官移植；金属β-内酰胺酶；肺炎克雷伯菌；肠杆菌科细菌

Treatment for abdominal infection caused by metallo-β-lactamase-producing Klebsiella pneumoniae in an
infant after liver transplantation：a case report and literature review
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LIU Donghua ，GUO Yanlei ，QU Haijun ，ZHOU Changkai ，QUAN Xianghua ，CUI Mengna ，LI Jing（1. Dept.
of Pharmacy，the Affiliated Hospital of Qingdao University，Shandong Qingdao 266000，China；2. Provincial
Tourism Resort Health Center of Tianheng Island in Jimo District of Qingdao City，Shandong Jimo 266209，
China）
ABSTRACT OBJECTIVE To investigate the treatment plan for aztreonam-resistant metallo-β-lactamase（MBL）-producing
Enterobacteriaceae infection in pediatric solid organ transplant recipients. METHODS The clinical data of aztreonam-resistant
MBL-producing Klebsiella pneumoniae caused intra-abdominal infection of an infant after liver transplantation were retrospectively
analyzed. Abdominal infection occurred after operation. The pathogenic bacterium was MBL-producing K. pneumoniae. The drug
sensitivity results showed that the infant was resistant to aztreonam. Based on the results of sensitivity test，polymyxin B combined
with tigecycline were selected as initial regimen. The treatment effect was poor，with recurrent disease and shock spots. The clinical
pharmacist assisted the clinician to formulate treatment regimen of ceftazidime avibactam 0.5 g，q8 h combined with aztreonam
0.18 g，q6 h. Relevant domestic and foreign literature were reviewed，and the treatment plan of MBL-producing Enterobacteriaceae
infection after solid organ transplantation was summarized. RESULTS & CONCLUSIONS The infant was finally cured and
discharged with ceftazidime avibatan combined and aztreonam. Several foreign literature reported that ceftazidime avibactam
combined with aztreonam could effectively treat the infection caused by aztreonam-resistant MBL-producing Enterobacteriaceae
infection in patients with organ transplantation. It is expected to be an effective treatment for aztreonam-resistant MBL-producing
Enterobacteriaceae infection in pediatric solid organ transplant recipients.
KEYWORDS ceftazidime avibactam；aztreonam；child；intra-abdominal infection；organic transplantation；metallo-β-lactamase；
Klebsiella pneumoniae；Enterobacteriaceae

在过去的 20 多年中，我国实体器官移植迅猛发展，
Δ 基金项目：“白求恩·求索-药学科研能力建设”项目（No.
B-19-H-20200622） 但同时出现了许多耐药菌，给器官移植带来了巨大的挑
＊主管药师，硕士。研究方向：临床药学。电话：0532-82915827。 战。实体器官移植受者一旦发生耐药菌感染，病死率可
E-mail：donghua0209@qdu.edu.cn
高达40.4％ 。其中耐碳青霉烯酶的肠杆菌科细菌（car-
[1]
# 通信作者：主任药师。研究方向：临床药学。电话：0532-
82911566。E-mail：lijing7112@qdu.edu.cn bapenemase-resistant Enterobacteriaceae，CRE）感染与严

中国药房 2022年第33卷第11期 China Pharmacy 2022 Vol. 33 No. 11 ·1397 ·