Fadel Marcus Vinícius Telles, Repka João Carlos, Cunha Cláudio Leinig Pereira da, Leão Maria Terezinha C
Federal University of Paraná, Curitiba, PR, Brazil.
Braz J Infect Dis. 2008 Oct;12(5):416-22. doi: 10.1590/s1413-86702008000500013.
This study tested the hypothesis that the use of corticosteroids prior to antibiotics can lower the mortality rate in severe infections by S. aureus or Gram-negative bacilli, using an animal model. This study was a prospective and controlled study, placed in a university laboratory. Seven hundred and sixty mice distributed into three groups (Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae infected). The interventions in each group were: I) infection control (intra-peritoneal); II) treatment solely with antibiotics (teicoplanin or amikacin); III) antibiotics administered prior to the corticosteroid (methylprednisolone); IV) antibiotics administered after the corticosteroid. Mortality in the E. coli group, subgroup I: 100%; subgroup II: 55% (p<0.001); subgroup III: 62.5% (p=0.2488, compared to subgroup II); subgroup IV: 20% (p<0.01 compared to subgroups II and III). Mortality in the K. pneumoniae group: subgroup I: 100%; subgroup II: 72.5% (p<0.01); subgroup III: 80% (p=0.215 compared to subgroup II); subgroup IV: 45% (p<0.01 compared to subgroups II and III). Mortality in the S. aureus group: subgroup I: 82.5%; II: 42.5% (p<0.001); subgroup III: 77.5% (p=0.2877 compared to subgroup I); subgroup IV: 32.5% (p=0.1792 compared to subgroup II). The use of corticosteroids prior to antibiotics lowered the mortality rate caused by Gram-negative bacteria and did not affect the mortality caused by S. aureus. When used after starting treatment with antibiotics, the corticosteroid was not superior to the use of antibiotics alone in the case of the Gram-negative bacteria, and was not significantly different from non-treatment of the infection, in the case of S. aureus.
本研究使用动物模型，检验了在使用抗生素之前先使用皮质类固醇可降低金黄色葡萄球菌或革兰氏阴性杆菌所致严重感染死亡率的假设。本研究是一项前瞻性对照研究，在大学实验室进行。760只小鼠被分为三组（分别感染金黄色葡萄球菌、大肠杆菌和肺炎克雷伯菌）。每组的干预措施如下：I）感染控制（腹腔内）；II）仅用抗生素治疗（替考拉宁或阿米卡星）；III）在皮质类固醇（甲泼尼龙）之前使用抗生素；IV）在皮质类固醇之后使用抗生素。大肠杆菌组的死亡率：I组：100%；II组：55%（p<0.001）；III组：62.5%（与II组相比，p=0.2488）；IV组：20%（与II组和III组相比，p<0.01）。肺炎克雷伯菌组的死亡率：I组：100%；II组：72.5%（p<0.01）；III组：80%（与II组相比，p=0.215）；IV组：45%（与II组和III组相比，p<0.01）。金黄色葡萄球菌组的死亡率：I组：82.5%；II组：42.5%（p<0.001）；III组：77.5%（与I组相比，p=0.2877）；IV组：32.5%（与II组相比，p=0.1792）。在抗生素之前使用皮质类固醇可降低革兰氏阴性菌所致的死亡率，但不影响金黄色葡萄球菌所致的死亡率。在开始使用抗生素治疗后使用皮质类固醇时，对于革兰氏阴性菌，其效果并不优于单独使用抗生素，对于金黄色葡萄球菌，其与不治疗感染无显著差异。
