Lee Nan-Yao, Yan Jing-Jou, Lee Hsin-Chun, Liu Kung-Hung, Huang Shao-Tsung, Ko Wen-Chien
Division of Infectious Diseases, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.
J Microbiol Immunol Infect. 2004 Dec;37(6):343-9.
The emergence of acquired metallo-beta-lactamase (MBL) in gram-negative bacilli is regarded as a therapeutic challenge since such enzymes are capable of hydrolyzing all beta-lactams in vitro except the monobactams. The clinical characteristics and outcome of 8 episodes of gram-negative bacteremia caused by MBL-producing isolates from January 1997 through December 2000 (Klebsiella pneumoniae, 6 isolates; Pseudomonas stutzeri, 4; Pseudomonas aeruginosa, 1; and Pseudomonas putida, 1) were analyzed. The median age of the patients was 61 years (range, 2-95 years). Most patients (n = 6, 75%) had more than 1 comorbid illness or condition and 6 patients acquired bacteremia in the intensive care unit. The median time from admission to the first positive culture was 34.5 days (range, 1-99 days). Pneumonia was the most common site of infection. Five patients (62.5%) received a carbapenem to treat bacteremia. The median time to defervescence was 6 days (range, 2-12 days). No bacteriologic failure was noted during or after antimicrobial therapy. The overall mortality rate from bacteremia caused by gram-negative, MBL-producing organisms was nil at 14 or 28 days.
革兰氏阴性杆菌中获得性金属β-内酰胺酶（MBL）的出现被视为一项治疗挑战，因为此类酶在体外能够水解除单环β-内酰胺类之外的所有β-内酰胺类抗生素。对1997年1月至2000年12月期间由产MBL菌株引起的8例革兰氏阴性菌血症的临床特征及转归进行了分析（肺炎克雷伯菌6株、斯氏假单胞菌4株、铜绿假单胞菌1株、恶臭假单胞菌1株）。患者的年龄中位数为61岁（范围2 - 95岁）。大多数患者（n = 6，75%）患有不止一种合并症或疾病状态，6例患者在重症监护病房获得菌血症。从入院到首次培养阳性的时间中位数为34.5天（范围1 - 99天）。肺炎是最常见的感染部位。5例患者（62.5%）接受碳青霉烯类药物治疗菌血症。退热时间中位数为6天（范围2 - 12天）。抗菌治疗期间及之后未发现细菌学治疗失败情况。由产MBL的革兰氏阴性菌引起的菌血症在14天或28天的总体死亡率为零。
