Chemoprophylaxis of gram-negative infections in neutropenic patients.
Chemoprophylaxis of gram-negative infections in neutropenic patients.
复制标题
中性粒细胞减少症患者革兰氏阴性菌感染的化学预防。
作者：
J. Klastersky
中性粒细胞减少患者的革兰氏阴性感染通常源于肠道菌群。为了减少这些感染的发生率，已经使用了几种胃肠道净化方案，其中一些已被证明是临床有用的。口服不可吸收的抗生素（氨基糖苷类、多粘菌素）可降低中性粒细胞减少期间革兰氏阴性脓毒症的发生率，但除奈替米星外，对这些药物的耐受性一般较差，依从性较低。甲氧苄啶-磺胺甲恶唑已广泛用于预防中性粒细胞减少症患者的感染。该药的临床结果相互矛盾，因为其疗效显然与所研究人群中病原体耐药性的流行病学模式有关。最近，喹诺酮类药物对患者耐受性良好，目前对大多数肠杆菌科菌株有效，与中性粒细胞减少患者的革兰氏阴性感染的实际根除有关。这些结果与革兰氏阳性感染的频率增加相一致，幸运的是，革兰氏阳性感染导致的死亡率远低于革兰氏阴性败血症。喹诺酮类药物被全身吸收的事实可能有助于解释它们在中性粒细胞减少症期间化学预防的功效。本文从“抗定植”、“选择性去污”和“细菌易位”等理论概念出发，讨论中性粒细胞减少期间革兰氏阴性感染的化学预防。
Gram-negative infections in neutropenic patients originate frequently from the gut flora. Attempts to decrease the incidence of these infections have utilized several regimens for gastrointestinal decontamination, of which some have proven to be clinically useful. Orally administered nonabsorbable antibiotics (aminoglycosides, polymyxins) can decrease the incidence of gram-negative sepsis during neutropenia, but, with the possible exception of netilmicin, tolerance to these agents is generally poor, and compliance is low. Trimethoprim-sulfamethoxazole has been used widely for the prophylaxis of infections in neutropenic patients. Clinical results with this agent have been conflicting, as its efficacy is clearly related to epidemiological patterns of resistance of the pathogens in the population under study. More recently, the quinolones, which are well tolerated by patients and are presently active on most strains of Enterobacteriaceae, have been associated with a virtual eradication of gram-negative infections in neutropenic patients. These results have been paralleled by an increase in the frequency of gram-positive infections, which, fortunately, cause an incidence of mortality that is much lower than that seen in gram-negative sepsis. The fact that the quinolones are absorbed systemically might help to explain their efficacy in chemoprophylaxis during neutropenia. This paper discusses the chemoprophylaxis of gram-negative infection during neutropenia in the light of theoretical concepts such as 'colonization resistance', 'selective decontamination', and 'bacterial translocation'.