Lautenbach E, Schuster M G, Bilker W B, Brennan P J
Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Clin Infect Dis. 1998 Nov;27(5):1259-65. doi: 10.1086/515002.
The incidence of bacteremia due to vancomycin-resistant Enterococcus (VRE) has increased markedly in recent years. We investigated the role of chloramphenicol in its treatment. All cases of VRE bacteremia occurring at our facility during a 45-month period were analyzed. The response to chloramphenicol, its effect on mortality, and the incidence of adverse effects were assessed. Fifty-one patients (65.4%) received chloramphenicol. Among patients in whom a response could be assessed, 22 (61.1%) of 36 demonstrated a clinical response, while 34 (79.1%) of 43 showed a microbiological response. Forty-two patients (53.8%) died as a result of the bacteremia. Although the mortality rate was lower for patients treated with chloramphenicol, the difference was not significant (odds ratio = 0.72; 95% confidence interval, 0.28-1.85; P = .49), nor was there an association between earlier initiation of therapy and reduced mortality (P = .45). In cases with central line-related bacteremia, there was no difference in mortality among patients treated with chloramphenicol, line removal, or both (P = .36). Although 16 patients (31.4%) had adverse effects, none could be definitely attributed to chloramphenicol. Although chloramphenicol was well-tolerated, no significant effect of its use on mortality could be demonstrated.
近年来，耐万古霉素肠球菌（VRE）所致菌血症的发病率显著上升。我们研究了氯霉素在其治疗中的作用。分析了我们机构在45个月期间发生的所有VRE菌血症病例。评估了对氯霉素的反应、其对死亡率的影响以及不良反应的发生率。51例患者（65.4%）接受了氯霉素治疗。在可评估反应的患者中，36例中有22例（61.1%）表现出临床反应，而43例中有34例（79.1%）表现出微生物学反应。42例患者（53.8%）因菌血症死亡。虽然接受氯霉素治疗的患者死亡率较低，但差异不显著（优势比=0.72；95%置信区间，0.28 - 1.85；P = 0.49），早期开始治疗与降低死亡率之间也没有关联（P = 0.45）。在与中心静脉导管相关的菌血症病例中，接受氯霉素治疗、拔除导管或两者兼用的患者死亡率没有差异（P = 0.36）。虽然16例患者（31.4%）有不良反应，但没有一例可明确归因于氯霉素。虽然氯霉素耐受性良好，但未显示其使用对死亡率有显著影响。
