腦室注射Colistin於多重抗藥性腦室炎之探討

Intraventricular Colistin in the Treatment of Ventriculitis Caused by Multidrug-Resistant Gram-Negative Bacteria

陳力宇(Li-Yu Chen) ； 林綺英(Chi-Ying Lin) ； 蔡佩玲(Pei-Ling Tsai) ； 廖玲巧(Lin-Chu Liao)

《臺灣臨床藥學雜誌》 29卷1期 (2021/01) Pp. 57-64

https://doi.org/10.6168/FJCP.202101_29(1).0007

摘要

多重抗藥性細菌造成之院內感染已成為加護病房感染控制要面臨的挑戰，又特別是在神經外科手術後發生之中樞神經系統感染，更是困難治療。根據衛生福利部疾病管制署的臺灣院內感染監視資訊系統之資料以及文獻資料顯示，目前造成院內感染常見之多重抗藥性菌株主要包括：鮑氏不動桿菌（Acinetobacter baumannii，包含Acinetobacter calcoaceticus、Acinetobacter baumannii complex）、陰溝腸桿菌（Enterobacter cloacae）、糞腸球菌（Enterococcus faecalis）與屎腸球菌（Enterococcus faecium）、大腸桿菌（Escherichia coli）、克雷伯氏肺炎桿菌（Klebsiella pneumoniae）、綠膿桿菌（Pseudomonas aeruginosa）、金黃色葡萄球菌（Staphylococcus aureus）等。其中，碳青黴烯類抗藥性鮑氏不動桿菌（carbapenem resistant A. baumannii, CRAB）造成之院內感染在臨床上雖然能使用colistin做有效治療，但是在治療神經外科手術後發生之腦室炎時，因colistin通過血腦障壁的濃度相當低，因此本篇案例主要探討利用靜脈合併腦室注射給藥（intraventricular）的方式治療因CRAB導致的腦室炎。

關鍵字

多重抗藥性菌株 ； carbapenems resistant Acinetobacter baumannii ； 腦室注射給藥 ； 腦室炎

並列摘要

Nosocomial infections caused by organisms resistant to multiple antibiotics have become an evolving challenge in intensive care units, especially when complications of meningitis or ventriculitis occur after neurosurgical procedures. According to current data from the Taiwan Nosocomial Infection Surveillance System and relevant literature, the most common multidrug-resistant organisms that cause nosocomial infections include Acinetobacter baumannii (including Acinetobacter calcoaceticus, Acinetobacter baumannii complex), Enterobacter cloacae, Enterococcus faecalis and Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus et al. For infections caused by carbapenem-resistant A. baumannii, colistin has been recognized as the preferred treatment agent. However, in post-neurosurgical ventriculitis, colistin has the poor penetrative ability through the blood-brain-barrier. Therefore, the administration of colistin via a combined intraventricular and intravenous route might be a promising therapeutic strategy.

並列關鍵字

Multi-Drug Resistant Organisms ； Carbapenems-Resistant Acinetobacter baumannii ； Intraventricular Route ； Ventriculitis