Simmen H P, Battaglia H, Kossmann T, Blaser J
Department of Surgery, University Hospital, Zürich, Switzerland.
World J Surg. 1993 May-Jun;17(3):393-7. doi: 10.1007/BF01658708.
Netilmicin and clindamycin were administered to 47 patients with an intraabdominal infection who underwent emergency laparotomy. Thirty-one patients were cured, seven were improved, and therapy failed in nine patients despite the fact that all aerobic bacteria isolated from these patients were sensitive to netilmicin as determined by standard in vitro susceptibility tests. The pH of peritoneal and drainage fluid collected intraoperatively and during follow-up correlated with clinical outcome. Acidic pH was found in 21 of 33 (64%) specimens sampled from patients with therapeutic failure compared to 17 of 80 (21%) obtained from the categories "cured" and "improved" (p < 0.001). Netilmicin concentrations in serum or peritoneal/drainage fluid did not correlate with clinical outcome. Netilmicin levels were above the minimal inhibitory concentration of the pathogens in 59 of 64 (92%) drainage fluid specimens in which aerobic bacteria were isolated. Aerobic bacteria were isolated in 91% of drainage fluid specimens if the pH was less than 7.0, compared to 37% if pH was more than 7.0 (p < 0.001). Reduction of pH antagonized aminoglycoside activity in vitro against clinical isolates of Escherichia coli. Surgical reexploration should be considered in cases of deterioration following a laparotomy associated with detection of acidic drainage fluid.
奈替米星和克林霉素用于47例接受急诊剖腹手术的腹腔内感染患者。31例患者治愈，7例好转，9例治疗失败，尽管通过标准体外药敏试验确定从这些患者中分离出的所有需氧菌对奈替米星敏感。术中及随访期间收集的腹腔和引流液的pH值与临床结果相关。治疗失败患者的33份标本中有21份（64%）pH值呈酸性，而“治愈”和“好转”组的80份标本中只有17份（21%）呈酸性（p<0.001）。血清或腹腔/引流液中的奈替米星浓度与临床结果无关。在分离出需氧菌的64份引流液标本中，有59份（92%）的奈替米星水平高于病原体的最低抑菌浓度。如果pH值小于7.0，91%的引流液标本中分离出需氧菌，而pH值大于7.0时这一比例为37%（p<0.001）。体外实验中，pH值降低会拮抗氨基糖苷类药物对临床分离大肠杆菌的活性。剖腹手术后若出现病情恶化且引流液呈酸性，应考虑再次手术探查。
