Yew W W, Kwan S Y, Ma W K, Khin M A, Mok C K
Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong.
Chest. 1989 Nov;96(5):1150-2. doi: 10.1378/chest.96.5.1150.
Infection of sternotomy wounds due to Mycobacterium fortuitum-chelonei complex postoperatively was noted in ten patients in 1987 and six patients in 1988 in our hospital. The first ten patients were treated with a combination of ofloxacin and amikacin, successfully in nine. In the six later patients, five had M fortuitum infection and one had M chelonei infection. In those five we used single daily-dose ofloxacin, 600 mg, in three with rapid clinical response and bacteriologic cure. The MIC of ofloxacin for these three isolates ranged from 0.32 mg/L to 1.25 mg/L, and peak serum level of ofloxacin assessed by high-performance liquid chromatography ranged from 4.1 mg/L to 8.0 mg/L. Monotherapy with ofloxacin is recommended for M fortuitum infection of wound and soft tissue, with in vitro susceptibility studies as a guide, pending further reinforcing clinical evidence.
1987年我院有10例患者术后发生偶然分枝杆菌-龟分枝杆菌复合群所致的胸骨切开伤口感染，1988年有6例。最初的10例患者采用氧氟沙星和阿米卡星联合治疗，9例成功治愈。后来的6例患者中，5例为偶然分枝杆菌感染，1例为龟分枝杆菌感染。在这5例患者中，我们对3例使用每日单剂量600mg氧氟沙星治疗，临床反应迅速且细菌学治愈。这3株分离菌对氧氟沙星的最低抑菌浓度为0.32mg/L至1.25mg/L，通过高效液相色谱法评估的氧氟沙星血清峰值浓度为4.1mg/L至8.0mg/L。对于伤口和软组织的偶然分枝杆菌感染，建议在体外药敏研究的指导下，以氧氟沙星进行单药治疗，等待进一步确凿的临床证据。
