Maviglia R, Nestorini R, Pennisi M
Department of Emergency Care, Catholic University, Roma, Italy.
Curr Drug Targets. 2009 Sep;10(9):895-905. doi: 10.2174/138945009789108846.
Multidrug resistant bacteria infections are associated with an increase in attributable mortality and morbidity in ICU patients. Unfortunately, an emerging resistance to novel antibiotics used in the therapy of gram negative and gram positive bacteria infections is often reported in literature. Old antibiotics have been reintroduced in clinical practice. In this review we report the efficacy and safety use of older antimicrobial agents in critically ill patients. Polymyxins are used for nosocomial infection caused by Pseudomonas aeruginosa and Acinetobacter baumannii resistant strains. Patients with polymyxin-only susceptible gram-negative nosocomial pneumonia are reported to be successfully treated with inhaled colistin. Isepamicin can probably be used in intensive care units that harbor Gram-negative bacteria resistant to other aminoglycosides. Fosfomycin may be a useful alternative to linezolid and quinupristin-dalfopristin in the treatment of Vancomycin Resistant Enterococci (VRE) infections in certain clinical situations, e.g. uncomplicated urinary tract infections. Chloramphenicol has a wide antimicrobial spectrum and excellent tissue penetration; though it is sometimes used empirically in the hospital setting for the treatment of patients with unknown source of fever, its role is still a matter of controversy. The colistin/rifampicin combination might have a synergistic effect in Acinetobacter baumannii and Pseudomonas aeruginosa infections. Fusidic acid is active against staphylococcal strains.
多重耐药菌感染与重症监护病房（ICU）患者的归因死亡率和发病率增加有关。不幸的是，文献中经常报道革兰氏阴性菌和革兰氏阳性菌感染治疗中使用的新型抗生素出现了新的耐药性。旧的抗生素已重新引入临床实践。在本综述中，我们报告了老年抗菌药物在危重症患者中的疗效和安全性。多粘菌素用于治疗由铜绿假单胞菌和鲍曼不动杆菌耐药菌株引起的医院感染。据报道，仅对多粘菌素敏感的革兰氏阴性医院获得性肺炎患者通过吸入多粘菌素可成功治疗。异帕米星可能可用于存在对其他氨基糖苷类耐药的革兰氏阴性菌的重症监护病房。在某些临床情况下，例如单纯性尿路感染，磷霉素可能是治疗耐万古霉素肠球菌（VRE）感染时替代利奈唑胺和奎奴普丁 - 达福普汀的有用药物。氯霉素具有广泛的抗菌谱和出色的组织穿透力；尽管有时在医院环境中经验性地用于治疗不明发热来源的患者，但其作用仍存在争议。多粘菌素/利福平联合用药在鲍曼不动杆菌和铜绿假单胞菌感染中可能具有协同作用。夫西地酸对葡萄球菌菌株有活性。
