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产吲朵金黄杆菌可以用替考拉宁治疗吗?

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发表于 2012-8-29 09:00:10 | 显示全部楼层

拙凌 发表于 2012-8-30 09:12
                               
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我对您的观点持保留意见。
我不是很懂药学,不过个人以为看一种药物是否有效首先应该是看其药理,然后才 ...
原来也不了解,所以特地咨询了感染方面的专家:万古霉素确实是对黄杆菌非常有效的一种药,黄杆菌也是万古霉素唯一有效的阴性杆菌,但是不能单用,一般需要联合利福平或复方SMZ-TMP使用,好像国外有许多这方面的研究。但是,是否使用替考拉宁尚不明确。






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发表于 2012-8-29 09:00:11 | 显示全部楼层

樵夫 发表于 2012-8-30 20:01
                               
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原来也不了解,所以特地咨询了感染方面的专家:万古霉素确实是对黄杆菌非常有效的一种药,黄杆菌也是万古 ...
查了一下,确实有一些文献支持:
Zhonghua Yi Xue Za Zhi (Taipei). 1999 Mar;62(3):125-32.
Flavobacterium meningosepticum bacteremia: an analysis of 16 cases.
Liu CE, Wong WW, Yang SP, Wang FD, Fung CP, You KW, Liu CY.
Source
Department of Medicine, Changhwa Christian Hospital, ROC.
Abstract
BACKGROUND:
Flavobacterium meningosepticum is an uncommon pathogen causing nosocomial pneumonia and meningitis in newborns. It is usually resistant to antimicrobial agents used to treat gram-negative bacilli. While the pathogen often results in high mortality and serious sequelae in newborns, it is also found to cause to disease in adults. Therefore, it is necessary to know the full spectrum of the infection in adults and to identify effective antimicrobial agents.
METHOD:
Microbiology logbooks were reviewed for F meningosepticum isolated from January, 1992, to March, 1996. The medical records of these patients were reviewed. Special attention was paid to clinical manifestations, underlying diseases, risk factors, treatments, and prognosis. Twenty-four antimicrobial agents were tested using antimicrobial susceptibility tests.
RESULTS:
Eighteen isolates of F meningosepticum were identified from 16 patients. There were 10 men and six women, with a mean age of 63.7 years. The clinical features of infection included fever (> or = 38 degrees C) in 13 patients, chills in seven, shortness of breath in four, rales or rhonchi in four, shock in three and flank pain in two. All except one patient survived without sequelae. Fifteen patients contracted F meningosepticum from nosocomial sources. Of them, seven were suspected to have acquired the pathogen from diagnostic or therapeutic procedures. Bacteremia occurred in these patients within a mean period of 2.2 days. The other eight patients suffered nosocomial bacteremia within a mean period of 33.4 days after admission. The suspected infection route was not identified in only one patient. The organism was resistant to penicillins, cephalosporins, aztreonam, imipenem, aminoglycosides and macrolides. Testing with lomefloxacin, ciprofloxacin and ofloxacin yielded 72.2%, 83.3% and 94.4% susceptibility rates, respectively. Rifampin (61.1%) and trimethoprim-sulfamethoxazole (TMP-SMX) (88.9%) were effective. Vancomycin and minocycline were 100% effective.
CONCLUSIONS:
F meningosepticum is an opportunistic pathogen of low virulence and rarely causes serious infections in adults. Reducing the use of unnecessary residual devices and invasive procedures may help reduce the incidence of infection. Therapeutic options include vancomycin, TMP-SMX, minocycline, rifampin or fluoroquinolones.






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发表于 2012-8-29 09:00:12 | 显示全部楼层

樵夫 发表于 2012-8-30 20:01
                               
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原来也不了解,所以特地咨询了感染方面的专家:万古霉素确实是对黄杆菌非常有效的一种药,黄杆菌也是万古 ...
多谢解答。看来有时候还真的不能想当然了,嘿嘿。






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发表于 2012-8-29 09:00:13 | 显示全部楼层

樵夫 发表于 2012-8-30 20:01
                               
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原来也不了解,所以特地咨询了感染方面的专家:万古霉素确实是对黄杆菌非常有效的一种药,黄杆菌也是万古 ...
赞同。
万古与替考同属糖肽类,由于二者结构有差异,作用部位不同,组织浓度不同,PD/PK不一样,替考不一定对黄杆菌有效?






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发表于 2012-8-29 09:00:14 | 显示全部楼层


有争议的问题总是会让我们学到更多专业的知识,实践出真知,我更好奇的是做了替考拉宁的药敏后,体外敏感吗?那么是否给那位病人用药了?效果如何呢?缭绕老师快给些进一步的提示吧!






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发表于 2012-8-29 09:00:15 | 显示全部楼层


我们不要低估临床感染病专家的智商,如果有好的办法,相信亦不会用这么不确定的笨办法!况且有很多文献支持和经验在!!两害相权取其轻相信此专家亦是了解的!如果人人都固步自封,均去嚼别人剩下的馍?为什么老外可以创新,而我们只能固步自封,永远落人后!






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