头孢哌酮哌拉西林与β内酰胺酶抑制剂对肺炎克雷伯菌的抑菌作用及耐药性分析  

Antibacterial action and drug resistance of cefoperazone and piperacillin plus β-lactamase inhibitors against Klebsiella pneumoniae

作　　者：牛记军 孔志斌[2] 钱力[3] Niu Jijun;Kong Zhibin;Qian Li(Department of Internal Medicine,YingZe District Central Hospital,Taiyuan 030008,China;不详)

机构地区：[1]太原市迎泽区中心医院内科,030008 [2]上海市第六人民医院呼吸科 [3]山西医科大学附属第一医院老年病科

出　　处：《中国药物与临床》2021年第24期3959-3962,共4页Chinese Remedies & Clinics

摘　　要：目的分析头孢哌酮、哌拉西林与β内酰胺酶抑制剂对肺炎克雷伯菌的抑菌作用及耐药性。方法以肉汤稀释法测定其最小抑菌浓度(MIC);以菌落数的对数为纵坐标,以培养时间为横坐标绘制杀菌曲线,计算抗生素后效应(PAE)、β内酰胺酶抑制剂后效应(PLIE)、亚抑菌浓度后效应(PASME);用K-B纸片扩散法对肺炎克雷伯菌进行药敏试验。结果与单方制剂相比,头孢哌酮和哌拉西林与β内酰胺酶抑制剂复方制剂对克雷伯菌的MIC明显降低;从杀菌曲线看,与单方制剂相比,复方制剂的杀菌曲线降低明显;单方及复方的肺炎克雷伯菌PAE相差较小;3种复合剂PLIE对于肺炎克雷伯菌均为正值;对于肺炎克雷伯菌,头孢哌酮和哌拉西林/舒巴坦(1/1)的PASME为0.35 h,头孢哌酮和哌拉西林/克拉维酸(4/1)、(8/1)的PASME分别为2.94 h、4.31 h;复合制剂与单剂相比,其耐药率明显降低(P<0.05),且产β内酰胺酶(ESBLs)株的耐药率显著高于非产ESBLs株(P<0.05)。结论与单方制剂相比,头孢哌酮和哌拉西林与β内酰胺酶抑制剂复方制剂具有更好的抗菌作用;可使抗菌药物的耐药性显著降低,具有临床应用价值。Objective To investigate the antibacterial action and drug resistance of cefoperazone and piperacillin plusβ-lactamase inhibitors against Klebsiella pneumoniae(KP).Methods Broth dilution method was used to determine the minimum inhibitory concentrations(MIC)of the antibacterials.An bactericidal curve was then generated with the logarithm of colony number as Y-axis and culture time as X-axis.Post-antibiotic effect(PAE),post-β-lactamase inhibitor effect(PLIE),and postantibiotic sub-MIC effect(PASME)were measured.K-B disc diffusion method was used to test the drug susceptibility of KP.Results Compared with single use,the MICs of cefoperazone-and piperacillin-β-lactamase inhibitor against Klebsiella was significantly reduced.Compared with single use,the combination preparations showed remarkably lower bactericidal curves.There seemed to be little difference in PAE against KP between single and combination use of the antibacterials.The PLIE against KP was positive for any of the three combination preparations.The PASME against KP was 0.35 h for cefoperazone-and piperacillin-sulbactam at ratio of 1:1;and 2.94 h and 4.31 h,respectively,for cefoperazone-and piperacillin-clavulanic acid at ratios of 4:1 and 8:1.Drug resistance was significantly reduced with combination preparations compared to single use(P<0.05),and was significantly higher with ESBLs-producing compared to non-ESBLs-producing strains(P<0.05).Conclusion Compared with single use,cefoperazone-and piperacillin-β-lactamase inhibitor combination preparations leads to better antibacterial activity with significantly reduced drug resistance,and therefore is useful in clinical practice.

关 键 词：头孢哌酮 哌拉西林 Β内酰胺酶抑制剂 肺炎克雷伯菌 

分 类 号：R965[医药卫生—药理学]