Anderson E T, Young L S, Hewitt W L
Am J Med. 1976 Oct;61(4):493-7. doi: 10.1016/0002-9343(76)90328-4.
Of 237 cases of gram-negative rod bacteremia observed at the UCLA Medical Center during a 12 month period, 52 (22 per cent) occurred while the patient was receiving antibiotics which inhibited the infecting organism by disc diffusion tests. One half of the plasma samples available from 42 such patients with "breakthrough" bacteremia had subinhibitory circulating antibiotic levels when cultures were positive. Sepsis documented within 72 hours of initiation of therapy was usually due to antibiotic-sensitive Esch. coli and was associated with inadequate antibiotic levels; the patient was usually treated with a penicillin or cephalosporin. The source of bacteremia was most frequently the urinary tract or the biliary tree. In contrast, sepsis occurring more than 72 hours after the administration of antibiotics was frequently caused by multiple antibiotic-resistant Esch. coli in patients treated with gentamicin in adequate dosage and was associated with leukopenia or undrained purulent collections. Therapy ultimately failed in 20 cases (48 per cent): in early "breakthrough" bacteremia, failure was associated with subinhibitory antibiotic levels, and in late "breakthrough" bacteremias with inadequate drainage or impaired host defenses.
在加州大学洛杉矶分校医疗中心12个月期间观察到的237例革兰氏阴性杆菌菌血症病例中，有52例（22%）发生在患者接受通过纸片扩散试验能抑制感染菌的抗生素治疗时。在42例发生“突破性”菌血症的此类患者中，一半可获得的血浆样本在培养阳性时循环抗生素水平低于抑菌浓度。在开始治疗72小时内记录到的脓毒症通常由对抗生素敏感的大肠杆菌引起，且与抗生素水平不足有关；患者通常接受青霉素或头孢菌素治疗。菌血症的来源最常见的是尿路或胆道。相比之下，在使用足够剂量庆大霉素治疗的患者中，抗生素给药72小时后发生的脓毒症常由多重耐药的大肠杆菌引起，且与白细胞减少或未引流的脓性积液有关。最终20例（48%）治疗失败：在早期“突破性”菌血症中，失败与低于抑菌浓度的抗生素水平有关，而在晚期“突破性”菌血症中，失败与引流不足或宿主防御受损有关。
