Successful treatment of persistent bacteremia due to vancomycin-resistant, ampicillin-resistant Enterococcus faecium.
Successful treatment of persistent bacteremia due to vancomycin-resistant, ampicillin-resistant Enterococcus faecium.
复制标题
成功治疗耐万古霉素、耐氨苄青霉素屎肠球菌引起的持续性菌血症。
DOI：
10.1089/mdr.1995.1.249
复制
发表时间：
1995
影响因子：
2.6
通讯作者：
Lance R. Peterson
中科院分区：
文献类型：
--
作者：
Endale T. Mekonen;G. Noskin;D. Hacek;Lance R. Peterson
耐万古霉素肠球菌的出现已成为许多医疗中心日益严重的问题。我们报道了一名患有耐万古霉素屎肠球菌菌血症的肝移植受者，在服用高剂量氨苄青霉素和庆大霉素后仍出现菌血症后，使用非常高剂量的连续输注氨苄青霉素/舒巴坦加庆大霉素成功治疗。在我们的机构，1994 年分离出的屎肠球菌有 83% 被氨苄西林/舒巴坦抑制，而氨苄西林在 MIC < 或 = 64 微克/ml 时的抑制率为 66%。这些菌株均不产生β-内酰胺酶，这表明舒巴坦可能对某些肠球菌具有无法解释的有益作用。虽然氨苄青霉素需要 < 或 = 8 微克/ml 的 MIC 才能被认为具有抗肠球菌活性，但可以安全地实现更高水平的氨苄西林或氨苄西林/舒巴坦。我们患者的反应和报告的体内数据对该病原体的未来治疗具有影响，并且可能需要重新评估临床实验室的药敏解释指南以及临床医生的治疗药物剂量。
Emergence of vancomycin-resistant enterococci has become an increasing problem in many medical centers. We report a liver transplant recipient with vancomycin-resistant Enterococcus faecium bacteremia who was successfully treated using very high dose continuous infusion ampicillin/sulbactam, plus gentamicin after he remained bacteremic on high dose ampicillin and gentamicin. At our institution, 83% of E. faecium isolates from 1994 were inhibited by ampicillin/sulbactam compared to 66% for ampicillin at an MIC < or = 64 micrograms/ml. None of these strains produced beta-lactamase, suggesting sulbactam may have an unexplained beneficial effect against some enterococci. Although an MIC of < or = 8 micrograms/ml is required for ampicillin to be considered active against enterococci, much higher levels of ampicillin or ampicillin/sulbactam are safely achievable. The response of our patient and the reported in vivo data have implications for future treatment of this pathogen, and may necessitate a reevaluation of susceptibility interpretation guidelines by clinical laboratories, and therapeutic drug dosing by clinicians.