Harris A, Torres-Viera C, Venkataraman L, DeGirolami P, Samore M, Carmeli Y
Department of Pathology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts 02215, USA.
Clin Infect Dis. 1999 May;28(5):1128-33. doi: 10.1086/514760.
We conducted a case-series study of multiresistant Pseudomonas aeruginosa in patients who did not have cystic fibrosis. Patient characteristics, antibiotic exposures, time course of emergence of resistance, and clinical outcomes were examined. Twenty-two patients were identified from whom P. aeruginosa resistant to ciprofloxacin, imipenem, ceftazidime, and piperacillin was isolated. Nineteen (86%) had clinical infection. Patients received prolonged courses of antipseudomonal antibiotics before isolation of multiresistant P. aeruginosa. Nine of 11 patients with soft-tissue infection exhibited resolution of clinical infection but usually required surgical removal of infected tissue with or without revascularization. Overall, three patients died. In two instances in which multiple isolates with different susceptibility profiles from the same patient were available, pulsed-field gel electrophoresis profiles of serial isolates were indistinguishable or closely related. This study illustrates that multiresistant P. aeruginosa emerges in a stepwise manner after exposure to antipseudomonal antibiotics and results in adverse outcomes.
我们对非囊性纤维化患者中的多重耐药铜绿假单胞菌进行了一项病例系列研究。研究了患者特征、抗生素暴露情况、耐药性出现的时间过程以及临床结局。共识别出22例患者，从中分离出对环丙沙星、亚胺培南、头孢他啶和哌拉西林耐药的铜绿假单胞菌。19例（86%）有临床感染。在分离出多重耐药铜绿假单胞菌之前，患者接受了长时间的抗假单胞菌抗生素治疗。11例软组织感染患者中有9例临床感染得到缓解，但通常需要手术切除感染组织，无论是否进行血管重建。总体而言，3例患者死亡。在两例可获得同一患者不同药敏谱的多个分离株的情况下，连续分离株的脉冲场凝胶电泳图谱无法区分或密切相关。本研究表明，多重耐药铜绿假单胞菌在接触抗假单胞菌抗生素后以逐步方式出现，并导致不良结局。
