Sorensen V J, Horst H M, Obeid F N, Bivins B A
Am Surg. 1986 Jul;52(7):391-4.
Five postoperative patients with respiratory failure and gram negative pneumonia unresponsive to systemic antimicrobials were treated with endotracheally instilled aminoglycosides. Sputum cultures in four patients grew Pseudomonas aeruginosa and, in the fifth, Enterobacter cloacae. The five patients had been treated systemically for an average of 13 days (range 9 to 19 days) without improvement prior to endotracheal antibiotic administration. The gram negative organisms disappeared from the sputum cultures in all patients within an average of 4 days (range 2 to 8 days) following initiation of endotracheal antibiotics. All five patients had continued clinical improvement manifest by improved chest radiographs, improved oxygenation, and absence of the offending organisms from sputum cultures. None of the patients died from their gram negative pneumonia. This success coupled with data from other investigators suggests that endotracheal antibiotics should be considered in life-threatening gram negative pneumonias that are unresponsive to conventional systemic antimicrobials.
五例术后发生呼吸衰竭且对全身应用抗菌药物无反应的革兰阴性菌肺炎患者接受了气管内滴注氨基糖苷类药物治疗。四名患者的痰培养结果显示有铜绿假单胞菌生长，第五名患者的痰培养结果显示有阴沟肠杆菌生长。这五名患者在气管内给予抗生素之前，平均接受了13天（范围为9至19天）的全身治疗，但病情并无改善。在开始气管内应用抗生素后，所有患者痰培养中的革兰阴性菌在平均4天（范围为2至8天）内均消失。所有五名患者的临床症状持续改善，表现为胸部X光片改善、氧合改善以及痰培养中未发现致病微生物。所有患者均未死于革兰阴性菌肺炎。这一成功案例以及其他研究者的数据表明，对于危及生命且对传统全身抗菌药物无反应的革兰阴性菌肺炎，应考虑使用气管内抗生素。
