泛耐药革兰氏阴性菌感染的结局
Outcome of infections due to pandrug-resistant (PDR) Gram-negative bacteria.
作者信息
Falagas Matthew E, Bliziotis Ioannis A, Kasiakou Sofia K, Samonis George, Athanassopoulou Panayiota, Michalopoulos Argyris
机构信息
Alfa Institute of Biomedical Sciences, Athens, Greece.
出版信息
BMC Infect Dis. 2005 Apr 8;5:24. doi: 10.1186/1471-2334-5-24.
BACKGROUND
The increasing problem of infections due to multidrug-resistant Gram-negative bacteria has led to re-use of polymyxins in several countries. However, there are already clinical isolates of Gram-negative bacteria that are resistant to all available antibiotics, including polymyxins.
METHODS
We present a case series of patients with infections due to pathogens resistant to all antimicrobial agents tested, including polymyxins. An isolate was defined as pandrug-resistant (PDR) if it exhibited resistance to all 7 anti-pseudomonal antimicrobial agents, i.e. antipseudomonal penicillins, cephalosporins, carbapenems, monobactams, quinolones, aminoglycosides, and polymyxins.
RESULTS
Clinical cure of the infection due to pandrug-resistant (PDR) Gram-negative bacteria, namely Pseudomonas aeruginosa or Klebsiella pneumoniae was observed in 4 out of 6 patients with combination of colistin and beta lactam antibiotics.
CONCLUSION
Colistin, in combination with beta lactam antibiotics, may be a useful agent for the management of pandrug-resistant Gram-negative bacterial infections. The re-use of polymyxins, an old class of antibiotics, should be done with caution in an attempt to delay the rate of development of pandrug-resistant Gram-negative bacterial infections.
背景
多重耐药革兰氏阴性菌引起的感染问题日益严重，导致多个国家重新使用多粘菌素。然而，目前已经出现了对包括多粘菌素在内的所有可用抗生素均耐药的革兰氏阴性菌临床分离株。
方法
我们报告了一系列因对所有测试抗菌药物（包括多粘菌素）耐药的病原体引起感染的病例。如果分离株对所有7种抗假单胞菌抗菌药物（即抗假单胞菌青霉素、头孢菌素、碳青霉烯类、单环β-内酰胺类、喹诺酮类、氨基糖苷类和多粘菌素）均耐药，则定义为泛耐药（PDR）。
结果
在6例使用黏菌素和β-内酰胺类抗生素联合治疗的患者中，有4例因泛耐药革兰氏阴性菌（即铜绿假单胞菌或肺炎克雷伯菌）引起的感染获得了临床治愈。
结论
黏菌素与β-内酰胺类抗生素联合使用，可能是治疗泛耐药革兰氏阴性菌感染的有效药物。在试图延缓泛耐药革兰氏阴性菌感染发生率的过程中，应谨慎重新使用多粘菌素这类古老的抗生素。
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