Hamada Yukihiro, Hirai Jun, Suematsu Hiroyuki, Yamagishi Yuka, Nicolau David P, Mikamo Hiroshige
Jpn J Antibiot. 2016 Oct;69(5):319-326.
Colistin is a polypeptide antibiotic of the polymyxin family (polymyxin E) which has been reported to be active against many multidrug-resistant (MDR) Gram-negative aerobic bacteria collected across the globe. While this agent was not currently licensed in Japan, the emergence of MDR organisms has necessitated its off-label used in the country. However, colistin was approved in March, 2015. This retrospective observational report includes nine patients with MDR Gram-negative infections due to Pseudomonas aeruginosa (n=6) and Klebsiella spp. (n=3) who received intravenous colistin therapy as part of their antimicrobial regimen. The median age and duration of administration were 40 years (range 7-90) and 8 days (range 1-19). Clinical success was observed in all eight patients for whom efficacy could be evaluated. Two patients encountered colistin related adverse effects 22.2% (2/9). In both cases the nephrotoxicity and dysgeusia resolved after discontinuation of colistin therapy. In vitro studies conducted with these clinical isolates of P aeruginosa displayed synergy with the combination of colistin plus ceftazidime, rifampicin, meropenem or aztreonam. This report provides early evidence that colistin is generally safe, effective and demonstrates in vitro synergy when used in combination for the management of MDR Gram-negative pathogens derived from Japanese patients.
黏菌素是多黏菌素家族的一种多肽抗生素（多黏菌素E），据报道对全球收集的许多耐多药（MDR）革兰氏阴性需氧菌具有活性。虽然该药物目前在日本未获许可，但耐多药菌的出现使得该国不得不使用其超说明书用药。不过，黏菌素于2015年3月获得批准。这份回顾性观察报告纳入了9例耐多药革兰氏阴性菌感染患者，这些感染由铜绿假单胞菌（n = 6）和克雷伯菌属（n = 3）引起，他们接受了静脉注射黏菌素治疗作为其抗菌治疗方案的一部分。患者的中位年龄和给药持续时间分别为40岁（范围7 - 90岁）和8天（范围1 - 19天）。在所有8例可评估疗效的患者中均观察到临床成功。2例患者（22.2%，2/9）出现了与黏菌素相关的不良反应。在这两例中，停用黏菌素治疗后肾毒性和味觉障碍均得到缓解。对这些铜绿假单胞菌临床分离株进行的体外研究显示，黏菌素与头孢他啶、利福平、美罗培南或氨曲南联合使用具有协同作用。本报告提供了早期证据，表明黏菌素在用于治疗源自日本患者的耐多药革兰氏阴性病原体时总体上是安全、有效的，并且联合使用时显示出体外协同作用。
