Cantón Rafael, Máiz Luis, Escribano Amparo, Olveira Casilda, Oliver Antonio, Asensio Oscar, Gartner Silvia, Roma Eva, Quintana-Gallego Esther, Salcedo Antonio, Girón Rosa, Barrio María Isabel, Pastor María Dolores, Prados Concepción, Martínez-Martínez María Teresa, Barberán José, Castón Juan José, Martínez-Martínez Luis, Poveda José Luis, Vázquez Carlos, de Gracia Javier, Solé Amparo
Servicio de Microbiología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, España; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, España.
Unidad de Bronquiectasias y Fibrosis Quística, Servicio de Neumología, Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigaciones Sanitarias (IRYCIS), Madrid, España.
Arch Bronconeumol. 2015 Mar;51(3):140-50. doi: 10.1016/j.arbres.2014.09.021. Epub 2015 Jan 20.
Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P.aeruginosa. At initial infection, inhaled colistin (0,5-2MU/tid), tobramycin (300mg/bid) or aztreonam (75mg/tid) with or without oral ciprofloxacin (15-20mg/kg/bid, 2-3weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P.aeruginosa infections and "patient-to-patient transmission" of this pathogen.
铜绿假单胞菌是囊性纤维化（CF）患者支气管肺部感染的主要病原体。它仅在感染早期可被根除，而在慢性感染或病情加重期间，治疗目标是降低其细菌载量。新生儿筛查以及药代动力学/药效学知识已经改变了CF患者的治疗管理。对于未感染铜绿假单胞菌的患者，应进行基于培养的微生物学随访。在初次感染时，推荐吸入多黏菌素（0.5 - 2MU/每日三次）、妥布霉素（300mg/每日两次）或氨曲南（75mg/每日三次），可加用或不加用口服环丙沙星（15 - 20mg/kg/每日两次，2 - 3周）。在慢性感染中，治疗基于持续使用多黏菌素或采用妥布霉素或氨曲南的28天间歇治疗方案。在轻度至中度病情加重期间，可口服环丙沙星（2 - 3周），而严重病情加重必须采用静脉联合治疗（β - 内酰胺类与氨基糖苷类或氟喹诺酮类联合）。未来的研究将支持抗生素轮换和/或新的联合治疗方法。还建议采取流行病学措施，以避免新的铜绿假单胞菌感染以及该病原体的“患者间传播”。
