Neu H C
Rev Infect Dis. 1985 Nov-Dec;7 Suppl 4:S778-82. doi: 10.1093/clinids/7.supplement_4.s778.
Infections caused by gram-negative bacteria have continued to be a major problem for hospitalized patients. Malignant necrotizing otitis due to Pseudomonas aeruginosa has been encountered with increasing frequency as the number of older diabetic patients has increased. Nosocomial sinusitis and bacteremia due to Escherichia coli, Klebsiella pneumoniae, Enterobacter species, or P. aeruginosa develop in hospitalized patients. Bacteremia due to E. coli, K. pneumoniae, or P. aeruginosa often follows instrumentation of the urinary, respiratory, or gastrointestinal tracts in the hospitalized patient. Mortality still is excessively high. Infections of skin structure, particularly decubitus ulcers in debilitated, bedridden patients, are due to a mixed gram-negative and anaerobic flora; frequently, P. aeruginosa and Enterobacteriaceae resistant to many older agents are the major pathogens. Similarly, osteomyelitis in patients who have undergone previous surgical procedures is caused by various multiply resistant Enterobacteriaceae and P. aeruginosa. In all of these situations, therapy has usually included an aminoglycoside. The availability of drugs such as aztreonam, which has activity directed at aerobic gram-negative bacilli, provides an alternative approach that has proved successful and can be evaluated in more detail in the coming years.
革兰氏阴性菌引起的感染一直是住院患者面临的主要问题。随着老年糖尿病患者数量的增加，由铜绿假单胞菌引起的恶性坏死性中耳炎的发病率也在不断上升。住院患者会发生由大肠杆菌、肺炎克雷伯菌、肠杆菌属或铜绿假单胞菌引起的医院获得性鼻窦炎和菌血症。住院患者在进行泌尿道、呼吸道或胃肠道器械操作后，常发生由大肠杆菌、肺炎克雷伯菌或铜绿假单胞菌引起的菌血症。死亡率仍然过高。皮肤结构感染，特别是体弱卧床患者的褥疮溃疡，是由革兰氏阴性菌和厌氧菌混合菌群引起的；通常，对许多老药耐药的铜绿假单胞菌和肠杆菌科细菌是主要病原体。同样，既往接受过外科手术患者的骨髓炎是由各种多重耐药的肠杆菌科细菌和铜绿假单胞菌引起的。在所有这些情况下，治疗通常包括使用氨基糖苷类药物。氨曲南等对需氧革兰氏阴性杆菌有活性的药物的出现，提供了一种已被证明成功的替代方法，并且在未来几年可以进行更详细的评估。
