Mall T, Follath F, Salfinger M, Ritz R, Reber H
Intensive Care Med. 1985;11(4):179-83. doi: 10.1007/BF00272399.
Ten critically ill patients presenting with nosocomial infection caused by Serratia marcescens (SM) not responding to prior chemotherapy were treated in an open study with Moxalactam (MOX) alone [6] or in combination with an aminoglycoside [4]. In initial disc diffusion tests, all isolates of SM were highly susceptible to MOX. Clinically, three patients were cured and four improved. Three patients died: one from SM pneumonia, one from gangrenous cholecystitis and another from ARDS. Bacteriologically, SM were eliminated from blood cultures in all seven patients with septicemia but were recovered post mortem from the lung of one patient. In three cases with localized infection, SM were eliminated once and persisted twice. Selection of resistant SM was observed in three patients but became clinically relevant in one case only. Resistant SM strains also showed reduced susceptibility to other cephalosporins and aminoglycosides. Emergence of enterococci occurred four times, in two cases with clinical consequences. MOX is a useful drug for the treatment of SM infections, but a definite risk of selecting multiresistant SM strains and of enterococcal overgrowth must be kept in mind.
十名患有由粘质沙雷氏菌（SM）引起的医院感染且对先前化疗无反应的重症患者，在一项开放性研究中接受了单独使用莫西拉坦（MOX）[6]或与氨基糖苷类药物联合使用[4]的治疗。在最初的纸片扩散试验中，所有SM分离株对MOX均高度敏感。临床上，三名患者治愈，四名患者病情改善。三名患者死亡：一名死于SM肺炎，一名死于坏疽性胆囊炎，另一名死于急性呼吸窘迫综合征（ARDS）。细菌学上，所有七名败血症患者的血培养中SM均被清除，但尸检时在一名患者的肺部再次检出。在三例局部感染病例中，SM被清除一次，持续存在两次。在三名患者中观察到了耐药SM的产生，但仅在一例中具有临床相关性。耐药SM菌株对其他头孢菌素和氨基糖苷类药物的敏感性也降低。肠球菌的出现有四次，其中两例具有临床后果。MOX是治疗SM感染的一种有用药物，但必须牢记存在选择多重耐药SM菌株和肠球菌过度生长的明确风险。
