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粘菌素为多肽类抗生素,在20世纪60年代用于治疗革兰阴性菌感染。但在20世纪80年代,粘菌素因其毒性反应以及一些新抗菌药的出现而几近弃用。然而,近年多药耐药革兰阴性菌感染的增多促使粘菌素再次用于临床。研究表明,粘菌素对多药耐药革兰阴性菌,特别对多药耐药的鲍曼不动杆菌和铜绿假单胞菌所致感染(如肺炎、菌血症、假体关节感染、尿路感染等)有良好疗效,临床有效率为66.7%~87%。粘菌素的不良反应主要为肾毒性和神经毒性。粘菌素肾毒性的发生率早年报道为26.1%,近年研究显示为14%;其神经肌肉阻滞反应近15年未见报道。目前,粘菌素的广泛使用已导致革兰阴性菌中耐药菌株的出现。因此,粘菌素使用时应注意用量用法、疗程、与其他肾毒性药物的联用以及肾功能不全患者的安全合理使用。
Colistin is a peptide antibiotic used to treat gram-negative infections in the 1960s. However, in the 1980s, colistin was almost abandoned because of its toxic effects and the emergence of some new antibacterials. However, the increase of multidrug-resistant Gram-negative bacteria in recent years has led to the re-clinical use of colistin. Studies have shown that colistin on multidrug-resistant Gram-negative bacteria, especially multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa infections (such as pneumonia, bacteremia, prosthetic joint infection, Urinary tract infection, etc.) have a good effect, the clinical effective rate was 66.7% ~ 87%. The main adverse reactions of colistin are nephrotoxicity and neurotoxicity. The incidence of colistin nephrotoxicity reported in early years was 26.1%, 14% in recent studies showed that its neuromuscular blockade response has not been reported for nearly 15 years. Currently, the widespread use of colistin has led to the emergence of resistant strains in Gram-negative bacteria. Therefore, the use of colistin should pay attention to dosage usage, treatment, and other nephrotoxic drugs combined with renal insufficiency and safe and rational use of patients.