University of Tennessee Health Science Center, Memphis, 38163, USA.
Ann Pharmacother. 2010 Oct;44(10):1665-8. doi: 10.1345/aph.1p217. Epub 2010 Aug 24.
To report a case of recurrent Stenotrophomonas maltophilia ventilator-associated pneumonia (VAP) that was successfully treated with doxycycline and aerosolized colistin.
A 28-year-old male was admitted with a severe head injury and required mechanical ventilation. The patient developed S. maltophilia VAP on hospital day 17, which was cured after 7 days of treatment with high-dose intravenous trimethoprim/sulfamethoxazole (TMP/SMX). However, on day 34, the patient developed recurrent S. maltophilia VAP that did not respond clinically or demonstrate eradication on follow-up culture after 10 days of TMP/SMX. At that time, TMP/SMX was discontinued and treatment was initiated with intravenous doxycycline and aerosolized colistin. The VAP episode was cured after 14 days of treatment with doxycycline/aerosolized colistin.
S. maltophilia is an emerging cause of VAP in some centers. This organism is associated with high mortality rates and has few treatment options because it is intrinsically resistant to most drug classes. Recent data suggest that doxycycline and aerosolized colistin each are effective in treatment of other multidrug-resistant organisms, such as Pseudomonas aeruginosa and Acinetobacter baumannii. However, this is the first report describing the use of this antibiotic regimen for S. maltophilia. High-dose TMP/SMX is considered to be the drug of choice primarily based on excellent in vitro activity. Few data exist on how to treat patients who fail therapy with TMP/SMX or cannot receive that drug because of resistance, allergy, or adverse events. Thus, it is important to report alternative methods for treating this infection.
The positive clinical response to doxycycline and aerosolized colistin seen in the patient described here suggests that this combination may be an alternative treatment in patients who fail initial treatment or cannot receive standard therapies.
报告 1 例成功使用多西环素和雾化黏菌素治疗反复嗜麦芽窄食单胞菌呼吸机相关性肺炎（VAP）的病例。
一名 28 岁男性因严重头部受伤入院，需要机械通气。患者在入院第 17 天发生嗜麦芽窄食单胞菌 VAP，经 7 天高剂量静脉注射复方磺胺甲噁唑（TMP/SMX）治疗后痊愈。然而，在第 34 天，患者发生复发性嗜麦芽窄食单胞菌 VAP，在 TMP/SMX 治疗 10 天后，临床症状无改善，随访培养也未根除。此时，停用 TMP/SMX，改用静脉注射多西环素和雾化黏菌素治疗。多西环素/雾化黏菌素治疗 14 天后，VAP 痊愈。
嗜麦芽窄食单胞菌在一些中心是 VAP 的新兴病因。该病原体与高死亡率相关，且治疗选择有限，因为其对大多数药物类别均固有耐药。最近的数据表明，多西环素和雾化黏菌素在治疗其他多药耐药菌，如铜绿假单胞菌和鲍曼不动杆菌方面均有效。然而，这是首例描述该抗生素方案治疗嗜麦芽窄食单胞菌的报告。主要基于体外活性，TMP/SMX 被认为是首选药物。对于 TMP/SMX 治疗失败或因耐药、过敏或不良反应而无法使用该药物的患者，如何治疗的相关数据很少。因此，报告治疗这种感染的替代方法很重要。
此处描述的患者对多西环素和雾化黏菌素的临床反应良好，表明对于初始治疗失败或不能接受标准治疗的患者，该联合治疗可能是一种替代治疗方法。
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