Torres A, de Celis R, Rabinad E, Marco F, Almela M, Deulofeu R, Rodriguez-Roisin R, Agusti Vidal A
Respiratory Diseases, Clinical Hospital of Barcelona, Spain.
Chemotherapy. 1989;35 Suppl 1:15-24. doi: 10.1159/000238716.
The combination aztreonam + cefotaxime (AZ + CE) was compared to amikacin + cefotaxime (AM + CE) in the treatment of nosocomial pneumonia acquired at the intensive-care unit. This study included a total of 33 patients fulfilling criteria for nosocomial pneumonia. 16 of them were randomly allocated to the AZ + CE group and 17 to the AM + CE group. The empirical treatment was effective for 78% of AZ + CE cases and 92% of AM + CE cases (p = NS). Clinical care was observed in 77% of cases (10 out of 13 evaluable) in the AZ group and in 75% of the group treated with AM (12 cases out of 16 evaluable; p = NS). In the evaluable cases, treatment failure was associated with injections due to the following organisms: Acinetobacter calcoaceticus (1) and Pseudomonas aeruginosa (1) in the AZ group and A. calcoaceticus (1) in the AM group. Superinfections were observed only in the AM group P. aeruginosa. A. calcoaceticus, Streptococcus viridans, Candida albicans, Aspergillus fumigatus and Serratia marcescens. Both the peak and through serum concentrations of AZ and AM were maintained within normal ranges. Finally, an impairment of renal tubular function was observed in the group of patients treated with AM, as measured by urinary levels of N-acetyl-beta-D-glucosaminidase and leucine aminopeptidase sequentially during the treatment. These changes in renal functions alterations mentioned were not observed in the AZ group. It is concluded that the AZ + CE combination is an effective empirical and active antibiotic treatment against severe nosocomial pneumonia. Aztreonam has no renal toxicity, which is an advantage to take into account in patients with altered renal function.
在重症监护病房获得性医院肺炎的治疗中，比较了氨曲南+头孢噻肟（AZ+CE）与阿米卡星+头孢噻肟（AM+CE）的联合用药效果。本研究共纳入33例符合医院肺炎标准的患者。其中16例被随机分配到AZ+CE组，17例被分配到AM+CE组。经验性治疗对78%的AZ+CE组病例和92%的AM+CE组病例有效（p=无显著差异）。AZ组77%的病例（13例可评估病例中的10例）和AM治疗组75%的病例（16例可评估病例中的12例）观察到临床治愈（p=无显著差异）。在可评估病例中，治疗失败与以下病原体引起的感染有关：AZ组的醋酸钙不动杆菌（1例）和铜绿假单胞菌（1例），以及AM组的醋酸钙不动杆菌（1例）。仅在AM组观察到二重感染，病原体为铜绿假单胞菌、醋酸钙不动杆菌、草绿色链球菌、白色念珠菌、烟曲霉和黏质沙雷菌。AZ和AM的血清峰浓度和谷浓度均维持在正常范围内。最后，在接受AM治疗的患者组中观察到肾小管功能损害，治疗期间依次通过尿N-乙酰-β-D-氨基葡萄糖苷酶和亮氨酸氨肽酶水平进行测定。在AZ组未观察到上述肾功能改变。得出结论，AZ+CE联合用药是治疗重症医院肺炎的一种有效的经验性和活性抗生素治疗方法。氨曲南无肾毒性，这在肾功能改变的患者中是一个需要考虑的优势。
