多重抗藥性腸桿菌之治療

10.6666/ClinMed.202102_87(2).0017

陳怡仁；林邑璁

腸桿菌（Enterobacteriaceae） ； 多重抗藥性（multidrug resistance） ； 廣效β-內醯胺酶（extended spectrum β-lactamase） ； 碳氫黴烯酶（carbapenemase） ； 抗生素治療（antimicrobial therapy）

臨床醫學月刊

87卷2期（2021 / 02 / 26）

114 - 118

繁體中文

多重抗藥性腸桿菌之感染，在治療方面仍面臨許多挑戰，並且可選擇的藥物不多。對於製造ESBL和Amp-C類水解酶的腸桿菌，carbapenem是首選的藥物，但過度使用carbapenem會造成其抗藥性的快速增加，因此其他藥物的選擇也需要被考量。針對製造ESBL的腸桿菌，β-lactam與β-lactamase inhibitor的複合物類的抗生素是最常使用來替代carbapenem的藥物。對製造Amp-C的腸桿菌，cefepime或是fluoroquinolone是其他的選擇。對carbapenem具抗藥性的腸桿菌（CRE），若是嚴重度高，就要考量使用多種藥物合併治療。可選擇的藥物有：colistin、tigecycline、aminoglycosides、fosfomycin等。近年也有幾種對CRE有效的抗生素被研發，例如：ceftazidime-avibactam、meropenem-vibrobactam等，但目前只有ceftazidime-avibactam在臺灣上市。總括來說，多重抗藥性腸桿菌的治療，需考量到病人不同的臨床狀況，感染部位，以及各菌種的抗藥性，如此才能選擇最適切的抗生素。

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