长疗程多黏菌素B治疗耐碳青霉烯类鲍曼不动杆菌脑脓肿1例

Long course of polymyxin B for the treatment of brain abscess caused by carbapenem resistant Acinetobacter baumannii: a case report

多黏菌素在耐碳青霉烯类革兰阴性杆菌(CRO)致严重感染中的临床疗效逐步得到认可,使用疗程一般为2~4周,静脉使用较常见的并发症是肾毒性及神经毒性,但目前关于多黏菌素长疗程使用的疗效及安全性鲜见报道。兰州大学第二医院神经外科重症监护病房(NICU)收治1例神经外科术后合并耐碳青霉烯类鲍曼不动杆菌(CRAB)感染致运动区脑脓肿的重症患者,在家属拒绝脓肿切除及Ommaya囊植入术的情况下,给予多黏菌素B静脉注射(3.0 mg·kg^(-1)·d^(-1))联合脑室内局部注射(5 mg、每日1次),同时静脉二联高剂量舒巴坦(8 g/d)抗感染治疗,最终患者脑脓肿吸收,成功治愈。多黏菌素B总疗程69 d,累积用量7500 mg,病程中并未发生多黏菌素相关肾毒性及神经毒性等并发症,也未出现呼吸抑制及神经肌肉阻滞等症状,但在多黏菌素B静脉用药1个月左右出现色素沉着,停药后消退。提示长疗程多黏菌素B用于CRAB所致的颅内感染安全有效。

The clinical efficacy of polymyxins in severe infection caused by carbapenem resistant organism(CRO)has gradually been recognized,and the course of treatment is generally 2 to 4 weeks.The most common complications after intravenous injection are nephrotoxicity and neurotoxicity,however,there are few reports on the efficacy and safety of the long course use of polymyxins.A patient with carbapenem resistant Acinetobacter baumannii(CRAB)infection after neurosurgery was admitted to the department of neurosurgical intensive care unit(NICU)of Lanzhou University Second Hospital.As the family refused the excision of brain abscess and Ommaya reservoir placement,polymyxin B was given intravenous(3.0 mg·kg^(-1)·d^(-1))combined with intrathecal(5 mg once daily)injection,and high-dose sulbactam(8 g/d)was intravenously injected for anti-infection therapy.Finally,the brain abscess was absorbed and the patient was successfully cured.The total course of polymyxin B was 69 days with a cumulative dosage of 7500 mg.There were no complications such as polymyxin-related nephrotoxicity and neurotoxicity during the period,and no symptoms of respiratory inhibition or neuromuscular blockage were observed,but polymyxin-related skin pigmentation appeared about 1 month after intravenous administration of polymyxins B,which subsided after drug withdrawal.It is suggested that long course of polymyxins B is safe and effective for intracranial infection caused by CRAB.