Oral ciprofloxacin plus colistin: prophylaxis against bacterial infection in neutropenic patients. A strategy for the prevention of emergence of antimicrobial resistance
Oral ciprofloxacin plus colistin: prophylaxis against bacterial infection in neutropenic patients. A strategy for the prevention of emergence of antimicrobial resistance
复制标题
DOI：
10.1046/j.1365-2141.2001.03034.x
复制
发表时间：
2001-10-01
影响因子：
6.5
通讯作者：
Kibbler, CC
中科院分区：
文献类型：
--
作者：
Prentice, HG;Hann, IM;Kibbler, CC
经过2年的研究，口服环丙沙星和粘菌素联合用药已连续使用10年，未出现耐药性。在为期 2 年（1987-1989）的时间里，我们在一项随机试验中比较了环丙沙星 + 粘菌素 (CIP + COL) 与新霉素 + 粘菌素 (NEO + - COL) - 选择组合是因为环丙沙星具有预防革兰氏阴性菌感染的潜力，并给予粘菌素以降低出现耐药性的风险。每组有 64 名具有相似人口统计数据的患者可进行疗效分析评估。与 NEO + COL 组患者相比，CIP + COL 组患者中性粒细胞减少症伴发热天数 (P < 0.001) 和静脉注射抗生素中性粒细胞减少症天数 (P < 0.001) 的比例显着降低。使用 CIP + COL 的患者总共发生了 54 次（细菌学记录的 15 次）发热发作，而使用 NEO + COL 的患者总共发生了 77 次（细菌学记录的 41 次）发热发作。 CIP + COL 组仅发生 2 例革兰氏阴性细菌感染，而 NEO + COL 组有 16 例。 CIP + COL 组没有发生金黄色葡萄球菌感染，而其他患者则有 10 例。从 CIP + COL 患者中分离出 2 株 CIP 耐药革兰氏阴性杆菌，而 NEO + COL 患者中分离出 13 株 NEO 耐药革兰氏阴性杆菌。在随后的十年中，中性粒细胞减少症患者一直沿用这种预防策略，1998 年 1 月至 1999 年 12 月 31 日期间的一项为期 2 年的随访研究显示，在 350-400 次中性粒细胞减少症发作期间，出现了 66 例显着感染。 111 株分离株中，有 8 株（7.2%）对环丙沙星具有耐药性，涉及 2% 的中性粒细胞减少症发作，表明粘菌素与环丙沙星联合用药的策略可有效预防中性粒细胞减少症患者的革兰氏阴性败血症，尽管医院和社区广泛同时使用喹诺酮类药物，但没有出现明显的耐药性。
Following a 2-year study, the combination of oral ciprofloxacin and colistin has been used continuously for 10 years without the emergence of resistance. During a 2-year period (1987-1989), we compared ciprofloxacin + colistin (CIP + COL) with neomycin + colistin (NEO + - COL) in a randomized trial - combinations chosen because of the potential for prophylaxis of Gram-negative infection by ciprofloxacin, with colistin given to reduce the risk of emergence of resistance. Sixty-four patients with similar demographics in each arm were evaluable for efficacy analysis. Patients on CIP + COL had a significantly lower proportion of neutropenic days with fever (P < 0.001) and neutropenic days on intravenous antibiotics (P < 0.001) than patients on NEO + COL. A total of 54 (15 bacteriologically documented) pyrexial episodes occurred in patients on CIP + COL and 77 (41 bacteriologically documented) in patients on NEO + COL. Only two Gramnegative bacterial infections occurred lathe CIP + COL arm compared with 16 in the NEO + COL arm. No Staphylococcus aureus infections occurred in the CIP + COL group compared with 10 in the other patients. Two CIP-resistant Gram-negative bacilli were isolated from patients cu CIP + COL compared with 13 NEO-resistant Gram-negative bacilli from patients on NEO + COL. Following a subsequent decade of unchanged use of this prophylactic strategy in neutropenic patients, a 2-year follow-up study between I January 1998 and 31 December 1999 showed 66 significant infections during 350-400 neutropenic episodes. Eight of the 111 (7.2%) isolates were with ciprofloxacin-resistant organisms, involving 2% of the neutropenic episodes, indicating that the strategy of combining colistin with ciprofloxacin has been effective in the prevention of Gram-negative sepsis in neutropenic patients without the emergence of significant resistance despite widespread concurrent hospital and community use of the quinolones.