角膜的綠膿桿菌感染－及綠膿桿菌對抗生素敏感性之變遷

Pseudomonas Corneal Infection-Study on Resistance to Antibiotics

賴泉源(Chyuan-Yuan Lai) ； 吳文權(Wen-Chyuan Wu) ； 王惠珠(Hwei-Zu Wang)

《中華民國眼科醫學會會刊》 21卷 (1982/05) Pp. 105-113

https://doi.org/10.30048/ACTASOS.198205.0018

摘要

收集本院眼科五年來的綠膿桿菌角膜潰瘍病例33例，其他各科綠膿桿菌感染病例3078例，來比較對三種常用抗生素：Colistin，Gentamycin與Amikacin敏感性和抗藥性，結果對Gentamycin的抗藥性逐年增高，而Colistin仍保持很高的敏感性，對Amikacin也有慢慢增加抗藥性的趨勢，同時提出二個特殊病例報告，以供參考。

並列摘要

There is strong evidence that some strains of Pseudomonas aeruginosa are resistant to currently available antibiotics, such as Gentamycin, Amikacin, etc. In this report, we compare the resistant rate and susceptible rate of Pseudomonas to Gentamycin, Amikacin and Colistin which are 3 of most popular and useful drugs against Pseudomonas eye infections. Two cases of pseudomonas keratitis that are resistant to Gentamycin and Amikacin but susceptible to Colistin were also reported.
33 cases of pseudomonas corneal infection and 3078 cases of pseudomonas infections from other departments than Ophthalmology were collected from Jan, 1977 to Oct. 1981. Standarized disk susceptibility test was performed for test of antimicrobial susceptibility. Interpretation of inhibition zones of test culture was shown as Table 1, that is ”R~+” for resistant, ”++, +++” for susceptible.
Table 2, 3 and fig. 1, 2 showed that resistant rate of Gentamycin was rapidly increasing from the 25% in 1977 up to 67% in 1981. We thought. that it was due to frequent and wide use of Gentamycin in recent ten years. The resistant rate of Amikacin was not high but gradually increasing in the field of Ophthalmology also. These suggested that certain resistant strains of Pseudomonas aeruginosa have already developed in our community. Therefore Gentamycin is no longer the most effective antibiotic against pseudomonas. In contrary, Colistin remained highly susceptible in the 5-year survey, although the resistant rate bad temporarily risen in 1978 and 1979.
Two cases illustrated in fig. 3, 4 showed that the pseudomonas corneal ulcers became more severe and progressive despite of prompt initiation of treatment with Amikacin in case 1; Gentamycin in case 2. Both ulcers in each case healed after the treatment was switched to Colistin which was highly susceptible to the organisms isolated.
The progression of Pseudomonas corneal infection is rapid and early diagnosis plus prompt initiation of treatment with effective antibiotics before the result of bacterial culture and sensitivity test are gained are of essential importance.
In our series of cases with Pseudomonas infection of cornea; Aminoglycosides, esp. Gentamycin showed moderately high rasistance. We feel it is safer and more effective to initiate treatment with Colistin as the first choice of antibiotic before laboratory report is obtained. In our experience, 0.3% solution prepared from injection powder and 3 to 15 mg. in 0.5 ml. for subconjunctival injection are effective and well toleratd.

並列關鍵字

Pseudomonas infection ； Colistin ； Gentamycin ； Amikacin