Use of aerosolized colistin sodium in cystic fibrosis patients awaiting lung transplantation
Use of aerosolized colistin sodium in cystic fibrosis patients awaiting lung transplantation
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DOI：
10.1097/00007890-199709150-00015
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发表时间：
1997-09-15
期刊：
影响因子：
6.2
通讯作者：
Keenan, RJ
中科院分区：
文献类型：
--
作者：
Bauldoff, GS;Nunley, DR;Keenan, RJ
背景在等待肺移植的囊性纤维化（CF）患者中，长期暴露于全身抗生素经常导致气道定植有耐药假单胞菌分离株。这种耐药性限制了免疫抑制开始后可用于感染的有效抗菌药物的库，并被认为是肺移植的理论威慑。20名患有“泛耐药”假单胞菌的CF移植候选者接受了雾化粘菌素钠（75 mg b.i.d.）的维持抗生素治疗，静脉注射抗生素也被淘汰了。其他10名CF候选人未使用粘菌素钠。每3-6周进行一次痰培养和抗生素敏感性检查。所有20名使用雾化粘菌素钠的候选人（100%）在平均45.1 +/- 20.2天内被假单胞菌的敏感分离株定殖。相比之下，10个CF移植候选者中只有3个（30%）没有使用粘菌素钠，后来成为敏感分离株的定植。未使用粘菌素钠的候选人中敏感微生物自发出现的平均时间为144.6 +/- 48.0天，显著长于使用粘菌素钠的候选人（P=0.007）。使用粘菌素钠的候选者中假单胞菌属再发展敏感菌株的发生率显著增加（P
Background. In patients with cystic fibrosis (CF) who are awaiting lung transplant, prolonged exposure to systemic antibiotics has frequently led to airway colonization with resistant isolates of Pseudomonas. This resistance limits the arsenal of effective antimicrobials available for infections after the initiation of immunosuppression and has been considered a theoretical deterrent to lung transplantation.Methods. Twenty CF transplant candidates with ''pan-resistant'' Pseudomonas received maintenance antibiotic therapy with aerosolized colistin sodium (75 mg b.i.d.), and intravenous antibiotics were eliminated. Ten other CF candidates did not use colistin sodium. Sputum cultures and antibiotic sensitivities were followed every 3-6 weeks.Results. All 20 candidates (100%) who used aerosolized colistin sodium became colonized with sensitive isolates of Pseudomonas in an average of 45.1 +/- 20.2 days. In contrast, only 3 of 10 CF transplant candidates (30%) who did not use colistin sodium later became colonized with sensitive isolates. The mean time to spontaneous emergence of sensitive organisms was 144.6 +/- 48.0 days in candidates who did not use colistin sodium and was significantly longer than in the candidates who used colistin sodium (P=0.007). The occurrence of redeveloping sensitive isolates of Pseudomonas was significantly greater in the candidates who used colistin sodium (P