Lekkas Anastasios, Gyi Khin M, Hodson Margaret E
Department of Cystic Fibrosis, Royal Brompton Hospital, Sydney Street, London, SW36NP, United Kingdom.
J Cyst Fibros. 2006 May;5(2):121-4. doi: 10.1016/j.jcf.2005.12.005.
Infections due to Burkholderia cepacia complex (Bcc) strains increase morbidity and mortality in cystic fibrosis (CF). Some transplant centres reject Bcc infected patients. We reviewed the results in patients treated with i.v temocillin.
Twenty-three patients who received 38 courses of temocillin (1988-1998) were identified from the CF database at Royal Brompton Hospital. In three patients' data were inadequate; therefore analysis was done in 20. Outcome was measured as improvement, deterioration or no change (compared to admission) in the following categories: clinical (temperature, dyspnoea, sputum volume, chest pain), physiological (FEV1, FVC, oxygen saturation) and inflammatory markers (WBC, ESR, CRP). Patients who improved in two categories were classified as having improved. Antibiotic sensitivities and outcome were recorded.
In 18 of 32 courses (56.25%) improvement occurred. The organism (Bcc) in eight patients' sputum became resistant (three died). The antibiotics was changed in five patients with Bcc strains sensitive to temocillin because of no improvement and one patient due to allergy (rash). The average time to the next i.v antibiotic was 41 days. Eight patients died (in three the Bcc strain was resistant to temocillin). Fourteen patients with Bcc were transplanted and eight patients survived. Another patient who developed Bcc infection post-operatively, failing to respond to temocillin.
These results suggest the potential benefit of i.v temocillin in CF patients with Bcc for exacerbations and at the time of transplantation.
洋葱伯克霍尔德菌复合体（Bcc）菌株感染会增加囊性纤维化（CF）患者的发病率和死亡率。一些移植中心拒收感染Bcc的患者。我们回顾了接受静脉注射替莫西林治疗的患者的结果。
从皇家布朗普顿医院的CF数据库中确定了23例接受38个疗程替莫西林治疗的患者（1988 - 1998年）。3例患者的数据不充分；因此对20例患者进行了分析。通过以下类别衡量结果：临床（体温、呼吸困难、痰量、胸痛）、生理（第一秒用力呼气容积、用力肺活量、血氧饱和度）和炎症标志物（白细胞、血沉、C反应蛋白），与入院时相比的改善、恶化或无变化情况。在两个类别中有所改善的患者被归类为有所改善。记录抗生素敏感性和结果。
32个疗程中有18个（56.25%）出现改善。8例患者痰液中的病原体（Bcc）产生耐药性（3例死亡）。5例对替莫西林敏感的Bcc菌株患者因无改善而更换抗生素，1例因过敏（皮疹）更换抗生素。下次静脉注射抗生素的平均时间为41天。8例患者死亡（3例Bcc菌株对替莫西林耐药）。14例感染Bcc的患者接受了移植，8例存活。另1例患者术后发生Bcc感染，对替莫西林无反应。
这些结果表明静脉注射替莫西林对患有Bcc的CF患者在病情加重时和移植时可能有益。
