抗生素对产超广谱β-内酰胺酶大肠埃希菌接种效应的探讨  

Study on Inoculum Effect of Antibiotics in Tests with Extended-Spectrum-Lactamase-Producing Escherichia coli

作　　者：关学芳[1] 李慧 

机构地区：[1]湖南省常德市疾病预防控制中心,湖南常德415000 [2]常德市武陵区疾病预防控制中心

出　　处：《实用预防医学》2011年第2期228-231,共4页Practical Preventive Medicine

摘　　要：目的探讨美罗培南、哌拉西林/他唑巴坦、头孢吡肟、头孢他定、头孢噻肟和头孢曲松6种常用抗生素药物对产超广谱β-内酰胺酶大肠埃希菌的接种效应。方法 按照临床实验室标准化研究所推荐的微量肉汤稀释法测定6种抗菌药物对19株产超广谱β-内酰胺酶大肠埃希菌在标准接种浓度(5×105cfu/ml)和高接种浓度(5×107cfu/ml)下的最低抑菌浓度。结果美罗培南对19株产超广谱β-内酰胺酶大肠埃希菌不存在接种效应,哌拉西林/他唑巴坦只对部分基因型超广谱β-内酰胺酶菌株存在接种效应,头孢吡肟、头孢他定、头孢噻肟和头孢曲松对所有受试菌株均存在接种效应。结论对于产超广谱β-内酰胺酶大肠埃希菌引起的重度感染的治疗首选美罗培南,对于轻中度感染需根据药敏结果酌情考虑哌拉西林/他唑巴坦,对于第三、四代头孢菌素即使体外实验敏感也不建议应用。Objective To explore the inoculum effects of meropenem,piperacillin/tazobactam,cefepime,ceftazidime,cefotaxime and ceftriaxone on extended spectrum beta-lactamases（ESBLs） producing Escherichia coli. Methods According to the broth microdilution method recommended by the Clinical Laboratory Standards Institute（CLSI）,the minimum inhibitory concentrations of the 6 antibiotics against 19 Escherichia coli strains producing extended spectrum β-lactamases in the standard inoculum（5×105 cfu/ml） and the high inoculation concentration（5×107 cfu/ml） were determined. Results The inoculum effect of meropenem against 19 Escherichia coli strains producing extended spectrum β-lactamases did not exist.The inoculum effects of piperacillin/tazobactam only existed in partial genotype strains producing extended spectrum β-lactamases.The inoculum effects of cefepime,ceftazidime,cefotaxime and ceftriaxone existed in all the tested isolates. Conclusions Meropenem is the first choice for treating the severe infection caused by ESBLs-producing Escherichia coli.Piperacillin/tazobactam should be considered for therapy of mild or moderate infection based on the results of the antibiotic susceptibility testing.The third and fourth generation cephalosporins are not recommended even if they are sensitive in vitro experiments.

关 键 词：超广谱Β-内酰胺酶 接种效应:大肠埃希菌 

分 类 号：R378.21[医药卫生—病原生物学]