Department of Epidemiology and Preventive Medicine, Monash University, Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia.
Curr Opin Infect Dis. 2010 Dec;23(6):554-9. doi: 10.1097/QCO.0b013e32833fb88c.
Melioidosis is an infectious disease caused by the soil-associated Gram-negative bacterium Burkholderia pseudomallei. This review summarizes the evidence underlying current antibiotic regimens and discusses future strategies to reduce mortality.
Although simple rapid diagnostics exist, they rely on the availability of direct specimen and are not commercially available. Serological tests and nucleic acid detection are not sufficiently specific or sensitive for routine clinical use. Since the original trials defining setting the standard of care as ceftazidime, no antibiotic regimens have been shown to be superior in comparative trials, but ongoing trials are evaluating the efficacy of meropenem (in intensive treatment) and (TMP-SMX) (for eradication treatment).
In endemic areas, empiric antibiotics should include agents active against melioidosis as well as the other common causes of severe sepsis. It is likely that future improvements in mortality will be the result of efforts to improve on the early recognition and management of severe sepsis generally.
类鼻疽是一种由土壤相关的革兰氏阴性细菌伯克霍尔德菌引起的传染病。本综述总结了当前抗生素治疗方案的依据，并讨论了降低死亡率的未来策略。
尽管存在简单的快速诊断方法，但它们依赖于直接标本的可用性，并且尚未商业化。血清学检测和核酸检测在常规临床应用中特异性和敏感性不足。自最初的试验将头孢他啶定义为标准治疗以来，没有任何抗生素方案在比较试验中显示出优越性，但正在进行的试验正在评估美罗培南（强化治疗）和（TMP-SMX）（清除治疗）的疗效。
在流行地区，经验性抗生素应包括对类鼻疽以及其他常见严重败血症的病原体有效的药物。未来死亡率的提高可能是由于努力改善严重败血症的早期识别和管理。
