对一些苛养菌引起相关感染的抗生素治疗
作者：胡云建 胡继红 张秀珍
单位：卫生部北京医院细菌室, 北京 100730
关键词：
中国新药杂志000434
由于抗生素、激素等的大量使用,使一些少见或实验室难培养的苛养菌的检出不断增 多,但目前对于此类细菌的药敏方法尚不完善或无判断标准。下面介绍对18种苛养菌感染症 的抗生素治疗。见表1。
表1 对一些苛养菌引起相关感染的抗菌药治疗 细菌名称
感 染
治疗的药物选择[1～4]
备 注
, http://www.100md.com
参考文献
首选抗
生素
可供选择的抗生素
伴放线放
线菌
心内膜炎
青霉素+氨基糖苷类
头孢菌素+氨基糖苷类、氯霉素、环丙沙
星、利福平 、四环素、复方新诺明、氨基
糖苷类
对氨苄西林和青霉素的
, http://www.100md.com
抗菌活性不稳定；
对克林霉素、红霉素、万古霉素效果不佳
5～11
溶血隐秘
杆菌
咽炎
红霉素
青霉素、氯霉素、克林霉素、红霉素、四环素
对复方新诺明耐药
11
腊样芽胞
杆菌
, http://www.100md.com
枯草芽胞
杆菌
侵袭的疾病
万古霉素、克林霉素
喹诺酮类、亚胺培南、氯霉素、红霉素、庆大霉素、四环素
腊样芽胞菌产生β-内酰胺酶，对β-内酰胺类
抗生素耐药,很多不产生此酶的腊
样芽胞菌则对这类抗生素敏感
12,13
百日咳
杆菌
, 百拇医药 百日咳
红霉素
复方新诺明、氯霉素、四环素
对红霉素耐药罕见
14,15
布鲁菌
布鲁菌病
(波状热)
四环素+链霉素或庆
大霉素
复方新诺明+庆大霉
素、氯霉素+链霉素、喹诺酮类、四环素+利
, http://www.100md.com
福平、头孢 他啶
对头孢菌素的抗菌活性不稳定；在体外对喹诺酮类抗
生素具有活性；如果体内单独用药,则具有较高复发率
5,16,17
空肠弯曲
杆菌
腹泻
喹诺酮类、红霉素
四环素、庆大霉素
对青霉素和头孢菌素耐药
18～20
胚胎弯曲
, http://www.100md.com
杆菌
败血症、脑膜炎、血管感染
亚胺培南
庆大霉素、氨苄西林
18～20
黄褐
二氧化碳
噬纤维菌
牙周炎、扁桃体炎、菌血症
克林霉素、阿莫
西林/棒酸
头孢西丁、氯霉素、亚胺培南、喹诺酮类、青霉素、四环素
, http://www.100md.com
对超广谱头孢菌素、青霉素、万古霉素的抗菌活性
不稳定；对氨基糖苷类、 复方新诺明耐药
21,22
狗咬
二氧化碳
噬纤维
菌(DF-2)
狗/猫咬伤、菌血症、脑膜炎
青霉素、克林霉素
红霉素、超广谱头孢
菌素、多西环素、亚胺培南、喹诺酮类、万古霉素
, 百拇医药
21,22
人类心
杆菌
菌血症、心内膜炎
青霉素、氨基糖苷类
超广谱头孢菌素+氨基
糖苷类、氯霉素、四环素
对氨基糖苷类、克林霉素、红霉素、万古霉素抗菌活性不稳定
5,10,23
JK群棒
状杆菌
败血症
, http://www.100md.com
万古霉素
环丙沙星、红霉素、青霉素+氨基糖苷类
只对万古霉素敏感；如考虑其他抗生素,则应做药敏实验
[ SQ*4]24～26
解脲
棒杆菌
泌尿道感染
万古霉素
只对万古霉素敏感,如考虑其他抗生素,则应做药敏实验
24～26
啮蚀
, 百拇医药 艾肯菌
口腔感染、叮咬伤口、心内膜炎
青霉素、氨苄西林、阿莫西林/棒酸、超广谱头孢菌素
氨苄西林、头孢西丁、超广谱头孢菌素、复方新诺明、喹诺酮类、多西环 素、亚胺培南、菌克单
对氨基糖苷类、克林霉素、红霉素、窄谱头孢菌耐药；有产生β-内酰胺酶株的报道
5,6,10,27～29
猪红斑
丹毒丝菌
局限皮肤的感染
青霉素、氨苄西林
, 百拇医药
超广谱头孢菌素、亚胺培南、喹诺酮类
对氯霉素、红霉素、四环素抗菌活性不稳定；
对氨基糖苷类 、复方新诺明、万古霉素耐药
4
土拉热弗
郎西斯菌
土拉菌病
链霉素、庆大霉素
氯霉素
30,31
金氏金菌
心内膜炎、败血症、关节炎
, 百拇医药
青霉素+氨基糖苷类
头孢菌素+氨基糖苷类
对克林霉素不敏感,对环丙沙星耐药
5,6,10,32
军团菌
军团病
喹诺酮类、红霉素+
利福平
复方新诺明、四环素
在体内对β-内酰胺类抗生素
和氨基糖苷类 无活性
5,33
, 百拇医药
单核细胞增生
李斯特菌
菌血症、脑膜炎
氨苄西林+庆大霉素
复方新诺明、红霉素
对头孢菌素耐药
[ SQ*4]5,34～36
多杀巴斯德菌
叮咬伤口、菌血症
青霉素
阿莫西林/棒酸、氨苄
西林/舒巴坦、超广
, 百拇医药
谱头孢菌素、四环素、氯霉素、环丙沙星、复方新诺明
对氨基糖苷类、克林霉素、窄谱头孢菌素、耐酶青霉素耐药
27,28
参考文献
1，Bartlett JG. Pocket book of infectious disease therapy. Willams & Wokins, hiladelphia,1997.
2，Letter TM. The choice of antibacterial drugs, In:Abramowicz M.(ed). The Medical Letter,1998,40,33
3，Mandell GL, Bennett MJE, Dolin R. Principles and ractices of infectio us diseases, 4th ed.New York.Churchill Livingstone,1995.
, 百拇医药
4，Sanford,JP, Gilbert DN,Moellering RC, et al. Guide to Antimicrobi al Therapy, 28th ed. Vienna, Virginia. Antimicrobial Therapy,Inc.,1998.
5，Berbari EF, Cockerill FR, Steckelberg JM.Infectiveendocarditis due to unusual or fastidious microorganisms.，Mayo Clin Proc, 1997， 72∶532
6，Clark RB, Joyce SE.Activity of meropenem and other antimicrobial ag ents against uncommon gramnegative organisms. J Antimicrob Chemother,1993, 3 2∶233
, http://www.100md.com
7，Kaplan AH, Weber DJ, Oddone EZ, et al. Perfect. 1989. Infectio n due to Actinobacillus actinomycetemcomitans:15 cases and review. Rev Infect Dis, 1993, 11∶46
8，Pajukanta R, Asikainen S, Saarela M,et al. In virto susceptibility of different serotypes of Actinobacillus actinomycetemocomitans. Scandonav J Dent Res, 1993, 101∶299
9，Pavicic MJ, AJ van winkelhoff, J. deGraaff. In vitro s usceptibilities of Actinobacillus actinomycetemcomitans to a number of antimicro bial combinations. Antimicrob Agents Chemother, 1992, 36∶2634
, 百拇医药
10，Wilson WR, Karchmer AW, Dajani AS, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, an d HACEK microorganisms. J Am Med Assoc, 1995, 274∶1706
11，Carlson P, Kontiainen S, Renkonen OV. Antimicrobial susceptibility of Arcano bacterium haemolyticum. Amtimicrob Agents Chemother, 1994, 38∶142
12，Drobniewski FA. Bacillus cereus and related species. Clin Micro Rev, 199 3, (6)∶324
, 百拇医药
13，Weber DJ, Saviter SM. Rutala WA, et al. In vitro susceptibility of Bacil lus spp. to selected antimicrobial agents. Antimicrob Agents Chemother, 198 8, 32∶642
14，Hoppe JE, Tschimer. T comparison of media for agar dilution susceptibility testing of Bordetella pertussis and Bordetella parapertussis. Eur J Clin Micro biol Infect Dis, 1995, 14∶775
15，Lewis K, Saubolle MA. Tenover FC, et al. Pertussis caused by an erythrom ycin-resistant strain of Bordetella pertussis. Ped Infect Dis J, 1995, 14∶3 88
, http://www.100md.com
16，Garcia-Rodriguez JA, MunozBellido JL, Fresnadillo MJ, et al. In vitro a ctivities of new macrolides and rifapenrine against Brucella spp. Antimicrob A gents Chemother, 1993, 37∶911
17，Solera J, Martinez-Alfaro E, Espinosa A. Recognition and optimum treatment of brucellosis. Drugs, 1997, (3)∶245
18，Gaudreau C, Gilbert H. Comparison of disc diffusion and agar dilution method s for antibiotic susceptibility testin of Campylobacter jejuni subsp. jejuni and Campylobacter coli. J Antimicrob Chemother, 1997,39∶707
, 百拇医药
19，Reina J, Ros MJ, Serra A.Susceptibilities to 10 antimicrobial agents of 1,22 0 Campylobacter strains isolated from 1987 to 1993 from feces of pediatric patie nts. Antimicrob Agents Chemother, 1994, 38∶2917
20，Sanchez R, Fernandez-Baca V, Diaz MD, et al. Evolution of susceptibili ties of Campylobacter spp. to quinolones and macrolides. Antimicrob Agents Che mother, 1994, 38∶1879
21，Roscoe DL, Zemcov SJV,Thornber D, et al. Antimicrobial susceptibilities and β-lactamase characterization of Capnocytophaga species. Antimicrob Agent s Chemother, 1992, 36∶2197
, 百拇医药
22，Rummens JL, Gordts B, HW van Landuyt.In vitro susceptibikity of Capnocyt ophaga to 29 antimicrobial agents. Antimicrob Agents Chemother, 1986, 30∶73 9
23，Le Quellec A, Bessis D, Perez C, et al. Endocarditis due to bela-lactam ase-producing Cardiobacterium hominis. Clin Infect Dis, 1994, 19∶994
24，Marttinez-Martinez L, Ortega M C, Suarez A I. Comparison of E-test with br oth microdilution and disk diffusion for susceptibility testing of coryneform ba cteria. J Clin Microbio, 1995, 33∶1318
, 百拇医药
25，Soriano F, Zapardiel J, Nieto E. Antimicrobial susceptibilities of Corynebac terium species and other non-spore forming garm-positive bacilli to 18 antimic robial agents. Antimicrob Agents Chemother, 1995, 39∶208
26，Weiss WK, Laverdiere M, Rivest R.Comparison of antimicrobial susceptibility of Corynebacterium species by broth microdiltion and disk diffusion. Antimi crob Agents Chemother, 1996, 40∶930
27，Goldstein EJ, Nesbit CA, Citron DM. Comparative in vitro activites of az ithromycin, Bay Y3118,levofloxacin, sparfloxacin, and 11 other oral agents again st 194 aerobic and anaerobic bite wound isolates. Antimicrob Agents Chemother, 1995, 39∶1097
, 百拇医药
28，Goldstein EJC. Bite wounds and infection. Clin Infect Dis, 1992, 14∶633
29，Lacroix JM, Walker C. Characterization of a β-lactamase found in eikenella corrodens. Antimicrob Agents Chermother, 1991, 35∶886
30，Baker CN, Hollis DG, Thornsberry C. Antimicrobial susceptibility testing of francisella tularensis with a modified Mueller-Hinton broth. J Clin Microbio , 1985, 122∶221
31，Enderlin G，Moralesl L，Jacobs RF, et al. Streptomycin and alternatice a ge nts ofr treatment of tularemia:review of the literature. Clin Infect Dis,199 4, 19∶42
, 百拇医药
32，Morrison VA, Wagner KF. Clinical manifestation of kingella kingae infectio n:case report and reciew. Rev Infect Dis, 1989，(1)∶776
33，Edelstein PH. Antimicrobial chemotherapy for legionnaires'disease: areview. Clin Infect Dis, 1995, 21 (Suppl):S265
34，Hof H, Nichterlein T,Kretschmar M. Management of listeriosis. Clin Microb iol Rev, 1997, 10∶345
35，Jones EM, Mac Gowan AP. Amtimicrobial chemotherapy of human infection due to Listeria monocytogenes, Eur J Clin Microbiol Infect Dis, 1995, 14∶165
36，MacGowan AP, Holt HA, Bywater MJ, et al. In virto susceptibility of Lis teria monocytogenes isolated in the UK and other listeria species. Eur J Clin Microbiol Infect Dis, 1990, (9)∶767
(收稿：1999-08-16), 百拇医药
单位：卫生部北京医院细菌室, 北京 100730
关键词：
中国新药杂志000434
由于抗生素、激素等的大量使用,使一些少见或实验室难培养的苛养菌的检出不断增 多,但目前对于此类细菌的药敏方法尚不完善或无判断标准。下面介绍对18种苛养菌感染症 的抗生素治疗。见表1。
表1 对一些苛养菌引起相关感染的抗菌药治疗 细菌名称
感 染
治疗的药物选择[1～4]
备 注
, http://www.100md.com
参考文献
首选抗
生素
可供选择的抗生素
伴放线放
线菌
心内膜炎
青霉素+氨基糖苷类
头孢菌素+氨基糖苷类、氯霉素、环丙沙
星、利福平 、四环素、复方新诺明、氨基
糖苷类
对氨苄西林和青霉素的
, http://www.100md.com
抗菌活性不稳定；
对克林霉素、红霉素、万古霉素效果不佳
5～11
溶血隐秘
杆菌
咽炎
红霉素
青霉素、氯霉素、克林霉素、红霉素、四环素
对复方新诺明耐药
11
腊样芽胞
杆菌
, http://www.100md.com
枯草芽胞
杆菌
侵袭的疾病
万古霉素、克林霉素
喹诺酮类、亚胺培南、氯霉素、红霉素、庆大霉素、四环素
腊样芽胞菌产生β-内酰胺酶，对β-内酰胺类
抗生素耐药,很多不产生此酶的腊
样芽胞菌则对这类抗生素敏感
12,13
百日咳
杆菌
, 百拇医药 百日咳
红霉素
复方新诺明、氯霉素、四环素
对红霉素耐药罕见
14,15
布鲁菌
布鲁菌病
(波状热)
四环素+链霉素或庆
大霉素
复方新诺明+庆大霉
素、氯霉素+链霉素、喹诺酮类、四环素+利
, http://www.100md.com
福平、头孢 他啶
对头孢菌素的抗菌活性不稳定；在体外对喹诺酮类抗
生素具有活性；如果体内单独用药,则具有较高复发率
5,16,17
空肠弯曲
杆菌
腹泻
喹诺酮类、红霉素
四环素、庆大霉素
对青霉素和头孢菌素耐药
18～20
胚胎弯曲
, http://www.100md.com
杆菌
败血症、脑膜炎、血管感染
亚胺培南
庆大霉素、氨苄西林
18～20
黄褐
二氧化碳
噬纤维菌
牙周炎、扁桃体炎、菌血症
克林霉素、阿莫
西林/棒酸
头孢西丁、氯霉素、亚胺培南、喹诺酮类、青霉素、四环素
, http://www.100md.com
对超广谱头孢菌素、青霉素、万古霉素的抗菌活性
不稳定；对氨基糖苷类、 复方新诺明耐药
21,22
狗咬
二氧化碳
噬纤维
菌(DF-2)
狗/猫咬伤、菌血症、脑膜炎
青霉素、克林霉素
红霉素、超广谱头孢
菌素、多西环素、亚胺培南、喹诺酮类、万古霉素
, 百拇医药
21,22
人类心
杆菌
菌血症、心内膜炎
青霉素、氨基糖苷类
超广谱头孢菌素+氨基
糖苷类、氯霉素、四环素
对氨基糖苷类、克林霉素、红霉素、万古霉素抗菌活性不稳定
5,10,23
JK群棒
状杆菌
败血症
, http://www.100md.com
万古霉素
环丙沙星、红霉素、青霉素+氨基糖苷类
只对万古霉素敏感；如考虑其他抗生素,则应做药敏实验
[ SQ*4]24～26
解脲
棒杆菌
泌尿道感染
万古霉素
只对万古霉素敏感,如考虑其他抗生素,则应做药敏实验
24～26
啮蚀
, 百拇医药 艾肯菌
口腔感染、叮咬伤口、心内膜炎
青霉素、氨苄西林、阿莫西林/棒酸、超广谱头孢菌素
氨苄西林、头孢西丁、超广谱头孢菌素、复方新诺明、喹诺酮类、多西环 素、亚胺培南、菌克单
对氨基糖苷类、克林霉素、红霉素、窄谱头孢菌耐药；有产生β-内酰胺酶株的报道
5,6,10,27～29
猪红斑
丹毒丝菌
局限皮肤的感染
青霉素、氨苄西林
, 百拇医药
超广谱头孢菌素、亚胺培南、喹诺酮类
对氯霉素、红霉素、四环素抗菌活性不稳定；
对氨基糖苷类 、复方新诺明、万古霉素耐药
4
土拉热弗
郎西斯菌
土拉菌病
链霉素、庆大霉素
氯霉素
30,31
金氏金菌
心内膜炎、败血症、关节炎
, 百拇医药
青霉素+氨基糖苷类
头孢菌素+氨基糖苷类
对克林霉素不敏感,对环丙沙星耐药
5,6,10,32
军团菌
军团病
喹诺酮类、红霉素+
利福平
复方新诺明、四环素
在体内对β-内酰胺类抗生素
和氨基糖苷类 无活性
5,33
, 百拇医药
单核细胞增生
李斯特菌
菌血症、脑膜炎
氨苄西林+庆大霉素
复方新诺明、红霉素
对头孢菌素耐药
[ SQ*4]5,34～36
多杀巴斯德菌
叮咬伤口、菌血症
青霉素
阿莫西林/棒酸、氨苄
西林/舒巴坦、超广
, 百拇医药
谱头孢菌素、四环素、氯霉素、环丙沙星、复方新诺明
对氨基糖苷类、克林霉素、窄谱头孢菌素、耐酶青霉素耐药
27,28
参考文献
1，Bartlett JG. Pocket book of infectious disease therapy. Willams & Wokins, hiladelphia,1997.
2，Letter TM. The choice of antibacterial drugs, In:Abramowicz M.(ed). The Medical Letter,1998,40,33
3，Mandell GL, Bennett MJE, Dolin R. Principles and ractices of infectio us diseases, 4th ed.New York.Churchill Livingstone,1995.
, 百拇医药
4，Sanford,JP, Gilbert DN,Moellering RC, et al. Guide to Antimicrobi al Therapy, 28th ed. Vienna, Virginia. Antimicrobial Therapy,Inc.,1998.
5，Berbari EF, Cockerill FR, Steckelberg JM.Infectiveendocarditis due to unusual or fastidious microorganisms.，Mayo Clin Proc, 1997， 72∶532
6，Clark RB, Joyce SE.Activity of meropenem and other antimicrobial ag ents against uncommon gramnegative organisms. J Antimicrob Chemother,1993, 3 2∶233
, http://www.100md.com
7，Kaplan AH, Weber DJ, Oddone EZ, et al. Perfect. 1989. Infectio n due to Actinobacillus actinomycetemcomitans:15 cases and review. Rev Infect Dis, 1993, 11∶46
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