每日一题_2023.08.26

An 82-year-old woman with chronic obstructive pulmonary disease is hospitalized for an acute exacerbation and is placed on ventilatory support. During the course of her hospitalization, she becomes febrile with an associated elevation in her WBC count. X-ray of the chest shows a new infiltrate in the right lower lobe. Sputum studies of the infiltrate show that it is the gram-negative bacillus Acinetobacter baumannii. She is treated with intravenous (IV) antibiotics. Several hours after starting IV antibiotics, the patient has a seizure that lasts 45 seconds. A subsequent lumbar puncture is negative. Which of the following antibiotics would most likely cause this effect?

一名患慢性阻塞性肺疾病的82岁女性因急性加重住院，并接受通气支持。在住院期间，患者出现发热，并伴有WBC计数升高。胸部x线检查显示右肺下叶有新发浸润。痰液检查显示为革兰阴性杆菌鲍曼不动杆菌。她接受了静脉(IV)抗生素治疗。静脉注射抗生素数小时后，患者出现持续45秒的癫痫发作。随后的腰椎穿刺结果为阴性。下列哪种抗生素最有可能引起这种效应?

(A) Gentamicin 庆大霉素

(B) Imipenem 亚胺培南

(C) Levofloxacin 左氧氟沙星

(D) Linezolid 利奈唑胺

(E) Rifampin 利福平

答案解析：

亚胺培南是碳青霉烯类的广谱、β-内酰胺酶耐药抗生素。这些药物在结构上类似于β-内酰胺类抗生素，但对β-内酰胺酶具有耐药性，并与西司他丁联用以降低肾脏代谢。亚胺培南可用于治疗革兰阳性菌和革兰阴性菌感染，是治疗不动杆菌和肠杆菌感染的一线疗法。亚胺培南对治疗耐甲氧西林金黄色葡萄球菌、屎肠球菌或表皮葡萄球菌无效。不良反应包括胃肠道不适、血栓性静脉炎、皮疹和癫痫发作。

正确答案：B