May Ian, Abu-Khdeir Maha, Blackwood Roland Alexander
Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA.
Infect Dis Rep. 2012 Sep 18;4(2):e36. doi: 10.4081/idr.2012.e36. eCollection 2012 Apr 27.
Infections caused by Pseudomonas aeruginosa are becoming more common and increasingly more difficult to treat due to the continued development of drug resistance. While sensitivity to colistin (polymyxin E) is well known, it is frequently avoided due to concerns of nephrotoxicity. Reported here is a case of a multi-drug resistance pseudomonal typhlitis, bacteremia and pleural cavity infection that required significant intensive care, and serial abdominal washouts. Intra-peritoneal tobramycin in combination with broad-spectrum intravenous antibiotics including colistin were used. Several instillations of tobramycin into the abdominal cavity along with concomitant IV administration of colistin, ceftazidime and tobramycin and per os colistin, tobramycin and nystatin resulted in the clearance of the pseudomonal infection without any evidence of toxicity from the treatment. Intra-abdominal tobramycin with parenteral colistin therapy can be used in complicated clinical settings with appropriate nephroprotection.
由于耐药性的不断发展，铜绿假单胞菌引起的感染越来越常见，且越来越难以治疗。虽然对黏菌素（多黏菌素E）敏感是众所周知的，但由于担心肾毒性，它经常被避免使用。本文报道了一例多药耐药性假单胞菌性盲肠炎、菌血症和胸腔感染病例，该病例需要大量重症监护和多次腹腔冲洗。采用腹腔内妥布霉素联合包括黏菌素在内的广谱静脉抗生素治疗。多次向腹腔内注入妥布霉素，同时静脉注射黏菌素、头孢他啶和妥布霉素以及口服黏菌素、妥布霉素和制霉菌素，结果假单胞菌感染得以清除，且没有任何治疗毒性的证据。腹腔内妥布霉素联合肠外黏菌素治疗可在有适当肾保护措施的复杂临床环境中使用。
