Schimpff S C
Ann Intern Med. 1980 Aug;93(2):358-61. doi: 10.7326/0003-4819-93-2-358.
During the past 10 years the concepts of total reverse isolation using laminar air flow rooms and alimentary canal microbial suppression using oral nonabsorbable antibiotics have each been proved effective in reducing serious infection for patients with profound, prolonged granulocytopenia. When these two modalities are combined, the net reduction in infections is about 75%. Oral nonabsorbable antibiotics, however, are poorly tolerated, costly, and frequently associated with the acquisition of resistant gram-negative rods when used outside the laminar air flow room setting. The concept of colonization resistance may be the new approach needed for microbial suppression of the nonisolated patient. If the anaerobic flora is undisturbed, newly acquired organisms generally cannot colonize the patient. Agents such as trimethoprim/sulfamethoxazole suppress many of the potentially pathogenic aerobic bacteria but not the anaerobes, leaving colonization resistance relatively intact. The result thus far has been a reduction in infection without a concurrent increase in colonization or infection by organisms resistant to the antimicrobial agents commonly used for therapy.
在过去10年中，使用层流空气流动室进行完全反向隔离的概念以及使用口服不吸收抗生素抑制消化道微生物的概念，均已被证明可有效减少严重粒细胞缺乏症患者的严重感染。当这两种方法结合使用时，感染的净减少率约为75%。然而，口服不吸收抗生素耐受性差、成本高，且在层流空气流动室环境之外使用时，经常与获得耐革兰氏阴性杆菌有关。定植抗性的概念可能是抑制非隔离患者微生物所需的新方法。如果厌氧菌群不受干扰，新获得的微生物通常无法在患者体内定植。甲氧苄啶/磺胺甲恶唑等药物可抑制许多潜在致病性需氧菌，但不能抑制厌氧菌，从而使定植抗性相对保持完整。迄今为止的结果是感染减少，同时对常用于治疗的抗菌药物耐药的生物体的定植或感染没有同时增加。
