Klekner Almos, Bagyi Kinga, Bognar Laszlo, Gaspar Attila, Andrasi Melinda, Szabo Judit
Department of Neurosurgery, Medical Health Science Center, University of Debrecen, Nagyerdei krt. 98, 4012 Debrecen, Hungary.
J Clin Microbiol. 2006 Sep;44(9):3418-21. doi: 10.1128/JCM.00893-06.
Nosocomial bronchopneumonia is a frequent complication in patients with chronic intratracheal intubation. Despite targeted antibiotic treatment, production of abundant bronchial secretion containing pathogen bacteria often tends to be chronic, and so mortality drastically increases. This problem led to an investigation of the penetration of five cephalosporin antibiotics into the sputum. Serum and sputum were collected from 24 chronically intubated patients having purulent nosocomial bronchopneumonia treated in an intensive care unit (ICU). Patients received the following doses intravenously every 24 h: five received 70 mg/kg of body weight cefuroxime, four received 110 mg/kg cefamandole, six received 80 mg/kg ceftriaxone, four received 80 mg/kg ceftazidime, and five received 80 mg/kg cefepime. Antibiotic concentrations in the serum and sputum were evaluated by capillary electrophoresis. MICs were determined for bacteria isolated from the purulent bronchial secretions. The mean levels of the cephalosporins in the sputum did not reach the MICs for the bacteria isolated from the same samples. Ceftriaxone was the only one of the investigated five cephalosporins that had a measurable concentration in the sputum (1.4 +/- 1.2 mg/liter). The low concentration of antibiotics in the purulent tracheobronchial secretion can be one of the many reasons for ineffective therapy of nosocomial bronchopneumonia in intubated patients in the ICUs. In the case of intubated or mechanically ventilated patients having chronic bronchopneumonia, determination of drug concentration in the bronchial secretion might be considered when selecting an antibiotic for treatment.
医院获得性支气管肺炎是慢性气管插管患者常见的并发症。尽管进行了针对性的抗生素治疗，但含有病原菌的大量支气管分泌物的产生往往呈慢性，因此死亡率大幅上升。这一问题促使人们对五种头孢菌素抗生素在痰液中的渗透情况进行研究。从24例在重症监护病房（ICU）接受治疗的患有化脓性医院获得性支气管肺炎的慢性插管患者中采集血清和痰液。患者每24小时静脉接受以下剂量：5例接受70mg/kg体重的头孢呋辛，4例接受110mg/kg的头孢孟多，6例接受80mg/kg的头孢曲松，4例接受80mg/kg的头孢他啶，5例接受80mg/kg的头孢吡肟。通过毛细管电泳评估血清和痰液中的抗生素浓度。测定从脓性支气管分泌物中分离出的细菌的最低抑菌浓度（MIC）。痰液中头孢菌素的平均水平未达到从相同样本中分离出的细菌的MIC。头孢曲松是所研究的五种头孢菌素中唯一在痰液中有可测量浓度（1.4±1.2mg/升）的药物。脓性气管支气管分泌物中抗生素浓度低可能是ICU中插管患者医院获得性支气管肺炎治疗无效的众多原因之一。对于患有慢性支气管肺炎的插管或机械通气患者，在选择抗生素进行治疗时，可能需要考虑测定支气管分泌物中的药物浓度。
