Krilov L R, Blumer J L, Stern R C, Hartstein A I, Iglewski B N, Goldmann D A
Rev Infect Dis. 1985 Jul-Aug;7 Suppl 3:S482-9. doi: 10.1093/clinids/7.supplement_3.s482.
Nineteen patients with pulmonary exacerbations of cystic fibrosis due to Pseudomonas aeruginosa were given imipenem/cilastatin for six to 10 days at dosages of 30-90 mg/kg per day. Mean Shwachman scores rose from 46.6 to 50.3 (P less than .001), clinical efficacy scores from 34.3 to 43.3 (P less than .001), vital capacity from 53.7% to 58.5% of the predicted value (P less than .01), forced expiratory volume in 1 sec from 39.5% to 42.6%, and partial pressure of oxygen in arterial blood from 68.2 mm Hg to 72.6 mm Hg. Treatment failed in only two instances. The concentration of P. aeruginosa in the sputum decreased to a modest extent (8.5 log10 cfu/ml on day 1, 8.1 log10 cfu/ml on day 10; P greater than .1). Four patients had imipenem-resistant strains of P. aeruginosa at the start of therapy, and 11 additional patients developed resistant strains during treatment; in eight patients greater than 90% of all Pseudomonas organisms in the sputum were resistant at the end of therapy. Six patients acquired Candida in their sputum. There was no correlation between bacteriologic improvement or the development of resistance to imipenem and either clinical outcome or improvement in pulmonary function. In summary, imipenem/cilastatin therapy is associated with a good clinical outcome in patients with cystic fibrosis, but resistance emerges rapidly.
19例因铜绿假单胞菌导致囊性纤维化肺部加重的患者接受了亚胺培南/西司他丁治疗，疗程6至10天，剂量为每日30 - 90mg/kg。平均施瓦克曼评分从46.6升至50.3（P <.001），临床疗效评分从34.3升至43.3（P <.001），肺活量从预测值的53.7%升至58.5%（P <.01），第1秒用力呼气量从39.5%升至42.6%，动脉血氧分压从68.2mmHg升至72.6mmHg。仅2例治疗失败。痰中铜绿假单胞菌浓度有一定程度下降（第1天为8.5 log10 cfu/ml，第10天为8.1 log10 cfu/ml；P >.1）。4例患者在治疗开始时就有对亚胺培南耐药的铜绿假单胞菌菌株，另外11例患者在治疗期间出现耐药菌株；8例患者在治疗结束时痰中超过90%的假单胞菌属微生物耐药。6例患者痰中出现念珠菌。细菌学改善或对亚胺培南耐药的发生与临床结局或肺功能改善之间均无相关性。总之，亚胺培南/西司他丁治疗对囊性纤维化患者临床结局良好，但耐药出现迅速。
