摘要
中枢神经系统(CNS)周围的屏障以及多重耐药菌的出现对有效治疗CNS感染提出了治疗挑战。万古霉素是一种糖肽类抗生素,用于治疗和预防由革兰阳性菌引起的各种细菌感染,包括耐甲氧西林金黄色葡萄球菌(MRSA)。它也用于肠球菌、链球菌和甲氧西林敏感的金黄色葡萄球菌(MSSA)等引起的感染。万古霉素被推荐作为颅内感染的一线治疗药物。然而,通过静脉(IV)输注给药时,万古霉素在脑脊液(CSF)中的渗透是有限的。万古霉素通过脑室内(IVT)给药可绕过血脑屏障直接到达目标部位,实现高浓度以获得更好的杀菌作用。万古霉素IVT给药的适应症主要包括对IV抗生素反应较差的脑膜炎、脑室炎、颅内装置感染和脑脓肿。本文综述了成人万古霉素IVT给药的研究现状,旨在为临床实践提供参考。根据现有证据,使用万古霉素IVT给药治疗CNS感染是安全有效的。万古霉素IVT给药的最佳给药方案需要考虑到不同患者CNS的病理生理学特点并根据具体情况进行临床判断。
The barriers around the central nervous system (CNS) together with the emergence of multiresistant pathogens pose a therapeutic challenge to the effective treatment of CNS infections. Vancomycin is a glycopeptide antibiotic that is used for the treatment and prevention of various bacterial infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). It is also utilized for enterococci, streptococci and methicillin-susceptible Staphylococcus aureus (MSSA) infections. Vancomycin is recommended as a first line treatment for CNS infections. However, vancomycin has a limited penetration in the cerebrospinal fluid (CSF) when administered by intravenous (IV) infusion. Administering vancomycin via intraventricular (IVT) route bypasses the blood-brain barrier to allow delivery directly to the desired site of action, achieving high concentrations for better bactericidal action. IVT vancomycin was indicated for treating meningitis, ventriculitis, intracranial device infections, and abscesses which are unresponsive to intravenous antibiotics. This article reviews current literature on IVT vancomycin in adults, aiming to provide reference for the clinical practice. Using IVT vancomycin to treat CNS infections appears safe and effective based on current evidence. The optimal regimens of IVT vancomycin requires considering the CNS pathophysiology of various patients and making clinical judgment on a case-by-case basis.
作者
卢翠翠
邹东娜
冷冰
张文
Lu Cui-cui;Zou Dong-na;Leng Bing;Zhang Wen(Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250021)
出处
《中国抗生素杂志》
CAS
CSCD
2019年第7期778-783,共6页
Chinese Journal of Antibiotics
