Calvo F, de Castro H, Brice P
Presse Med. 1986 Dec 20;15(46):2353-7.
Two hundred and fifty patients (mean age 39 years) were involved in a multicentric pilot trial aimed at evaluating the effectiveness of a piperacillin (P) + amikacin (A) combination in severe neutropenic patients (less than 500 PNN/microliters). In patients who failed to improve under this combination vancomycin (V) was added. Two hundred and thirty-five patients were assessable for response to P + A. The infection was microbiologically undocumented in 148 of them (63%) and documented in 87 (37%). Response rates were 64% and 53% respectively, rising to 73% in both groups after addition of vancomycin. Thirty p. 100 of the patients had bacteremia. The most frequently encountered pathogens were staphylococci, enterobacteria, streptococci and Pseudomonas aeruginosa. Sixty-six p. 100 of gram-negative and staphylococcal infections responded to the P + A combination, while the response rate of staphylococcal infections was 23%. Fifty-seven p. 100 of staphylococci resistant to P + A were controlled by P + A + V. Fifteen (6.4%) patients died of infection, 5 of them of fungal infection. Toxicity was mild, with 3% renal toxicity. The P + A combination is effective as first line therapy in febrile neutropenic patients. These results and epidemiological data suggest that this combination plus vancomycin would be a suitable second line therapy for patients who did not improve.
250名患者（平均年龄39岁）参与了一项多中心试点试验，旨在评估哌拉西林（P）+阿米卡星（A）联合用药对严重中性粒细胞减少患者（低于500个中性粒细胞/微升）的有效性。对该联合用药治疗效果不佳的患者加用万古霉素（V）。235名患者可评估对P+A的反应。其中148例（63%）感染在微生物学上未得到证实，87例（37%）得到证实。有效率分别为64%和53%，加用万古霉素后两组有效率均升至73%。30%的患者发生菌血症。最常见的病原体为葡萄球菌、肠杆菌、链球菌和铜绿假单胞菌。66%的革兰阴性菌和葡萄球菌感染对P+A联合用药有反应，而葡萄球菌感染的有效率为23%。对P+A耐药的葡萄球菌中，57%被P+A+V控制。15例（6.4%）患者死于感染，其中5例死于真菌感染。毒性轻微，肾毒性为3%。P+A联合用药作为发热性中性粒细胞减少患者的一线治疗有效。这些结果和流行病学数据表明，对于治疗效果不佳的患者，该联合用药加用万古霉素将是一种合适的二线治疗方法。
