碳青霉烯类、复方酶抑制剂抗生素对产ESBLs菌株血清杀菌活性的研究  

The Research of β-lactams/β-lactamases Inhibitors and Carbapenems to ESBLs-producing Klebsiellae Pneumonia and Escherichia Coli

作　　者：王卫振[1] 吴立平[2] 张欣[1] 姜利芹 

机构地区：[1]潍坊医学院内科学教研室,山东潍坊261053 [2]潍坊市人民医院呼吸内科 [3]潍坊寒亭区开元街道卫生院

出　　处：《潍坊医学院学报》2014年第4期248-250,共3页Acta Academiae Medicinae Weifang

摘　　要：目的评价β内酰胺类/β-内酰胺酶抑制剂复方及碳青霉烯类抗菌药物对产超广谱β内酰胺酶(ESBLs)的肺炎克雷伯杆菌、大肠埃希菌感染的临床疗效,探讨临床产ESBLs菌感染的抗生素应用。方法通过测定静滴美洛西林舒巴坦、头孢哌酮舒巴坦、哌拉西林他唑巴坦、碳青霉烯类抗生素的惠者血清杀菌活性(SBA),分析药物疗效,SBA≥1:8表示治疗有效。结果①对产ESBLs肺炎克雷伯菌:美洛西林舒巴坦组、头孢哌酮舒巴坦组的SBA均小于1:8。哌拉西林他唑巴坦组SBA≥1:8有5例,碳青霉烯类组SBA≥1:8有8例。②对产ESBLs大肠埃希菌:美洛西林舒巴坦组的血清杀菌活性均<1:8。头孢哌酮舒巴坦组的SBA≥1:8有5例,哌拉西林他唑巴坦组SBA≥1:8有4例,碳青霉烯类组的SBA≥1:8有9例。结论美洛西林舒巴坦对产ESBLs的肺炎克雷伯菌及大肠埃希菌血清杀菌活性均较低,临床应用效果可能较差。对于产ESBLs菌株所致的感染,建议首选碳青霉烯类药物,避免选择β内酰胺类药物,尤其是第三代头孢菌素。若感染程度轻,可根据药敏结果选用β内酰胺/β-内酰胺酶抑制剂,对于严重感染患者,首选碳青霉烯类抗菌药物。Objective To evaluate the clinical curative effect between β-lactams/β-lactamases inhibitors and Carbapenems to ESBLs-producing Klebsiellae pneumonia and Escherichia coli and investigate the clinical application of antibiotics in the infection of ESBLs -producing bacteria.Methods To determine the serum bactericidal activity （SBA） of patients using mezlocillin/sulbactam（MLBT）,cefopera-zone/sulbactam（CPZ/SBT）,piperacillin/tazobactam（PIP/TAZ） and Carbapenems,the clinical application curative effect were analyzed . SBA≥1∶8 could be considered as effective in therapy .Results ①To ESBLs-producing Klebsiellae pneumonia：the SBA of MLBT groups and CPZ/SBT groups were all smaller than 1∶8.The number of SBA lager than 1∶8 in PIP/TAZ groups were five,while the Carbapenems groups were eight.②To ESBLs-producing Escherichia coli：the SBA of MLBT groups were all smaller than 1∶8.The number of SBA lager than 1∶8 in CPZ/SBT groups were five , comparing to PIP/TAZ groups were four .The number of SBA lager than 1∶8 in Carbapenems groups were nine .Conclusions In order to cure the infections of ESBLs-producing bacteria ,to choose Carbapenems antibiotics as the best therapy,avoiding of choosing β-lactams antibiotics,especially the third cephalosporin .If the gradient of infection is not severe ,choosing β-lac-tams/β-lactamases inhibitors according to drug susceptibility .If the gradient of infection is severe ,Carbapenems should be the best choice .

关 键 词：超广谱Β内酰胺酶 血清杀菌活性 肺炎克雷伯菌 大肠埃希菌 

分 类 号：R969.4[医药卫生—药理学]