中国铜绿假单胞菌下呼吸道感染诊治专家共识（2022年版）

中华结核和呼吸杂志2022年8月第45卷第8期Chin J T山ere Respir Dis,August2022.Val.45.No.8·739··诊疗方案·中国铜绿假单胞菌下呼吸道感染诊治专家共识(2022年版)中华医学会呼吸病学分会感染学组通信作者：瞿介明，上海交通大学附属瑞金医院呼吸与危重症医学部，上海200025，Email:jmqu0906@163.com;施毅，解放军东部战区总医院呼吸与危重症医学科，南京210002,Email:shivi56@126.com【摘要】铜绿假单胞菌是难治性下呼吸道感染最常见致病菌之一，由于其耐药严重和易形成生物被膜，特别是近10多年来碳青霉烯类耐药株的出现，使其治疗更为困难：同时新的治疗药物和治疗策略不断问世，有必要加以评估以指导临床合理应用。中华医学会呼吸病学分会感染学组在《铜绿假单胞菌下呼吸道感染诊治专家共识(2014年版)》的基础上进行更新，并以临床诊治和预防的思路和技术为重点，以期为临床医生规范化诊治铜绿假单胞菌下呼吸道感染提供切实可行的参考。国际实践指南注册号：PGRP-2021CN028Chinese expert consensus on the management of lower respiratory tract infections ofPseudomonas aeruginosa in adults(2022)Pulmonary Infection Assembly of Chinese Thoracic SocietyCorresponding author:Qu Jieming,Department of Pulmonary and Critical Care Medicine,RuijinHospital,Institute of Respiratory Diseases,Shanghai Jiaotong University School of Medicine,Shanghai200025,China,Email:jmqu0906@163.com;Shi Yi,Department of Respiratory and Critical CareMedicine Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China,Email-shiyi56@126.c0mAbstract Pseudomonas aeruginosa(PA)is the second common Gram-negative bacteriumfor hospital acquired pneumonia(HAP)in China(16.9%-220%).The proportion of PA in communityacquired pneumonia (CAP)was about 1.0%,while increased to 18%-8.3%in severe CAP.PAaccounted for 67.0%of CAP in patients with a history of PA infection,bronchiectasis,very severechronic obstructive pulmonary disease (COPD)or tracheotomy.Considering the high disease burdenof lower respiratory tract infections (LRTIs)caused by PA,together with the progress in this field inrecent years,the Pulmonary Infection Assembly of Chinese Thoracic Society updated the "Chineseexpert consensus on the management of lower respiratory tract infections of Pseudomonasaeruginosa in adults (2014 version)",focusing on pathogen detection,diagnosis,antimicrobialtherapy,comprehensive management,infection prevention and control.PA causes both acute and chronic LTRIs.Acute LRTIs mainly include pneumonia (CAP HAP andventilator-associated pneumonia),tracheobronchitis,lung abscess and empyema.The diagnosis ofchronic LTRIs should be based on a comprehensive assessment of (1)underlying chronic structurallung diseases,such as bronchiectasis,cystic fibrosis,COPD,or immunocompromised conditions;(2)the presence of clinical manifestations of LRTIs;and (3)two times (at least 3 months apart)ofPA detected from eligible lower respiratory tract specimens within 1 year.It is important todistinguish infection from colonization when PA is isolated from lower respiratory tract specimens.D0L:10.3760/cma.j.cm112147-20220407-00290收稿日期2022-04-07本文编辑吕小东引用本文：中华医学会呼吸病学分会感染学组.中国铜绿假单胞菌下呼吸道感染诊治专家共识(2022年版)[U1中华结核和呼吸杂志，2022.45(8)739-752.D0:10.3760/cma.j.cn112147-20220407-00290