β-内酰胺类抗生素对儿科常见革兰阴性杆菌体外抗菌活性的比较分析

Comparison of in vitro antibacterial activity of β-lactams against clinical isolates of gram negative bacilli stratus

目的:调查6种β鄄内酰胺类抗生素对儿科常见革兰阴性杆菌的体外抗菌活性。方法:采用法国生物鄄梅里埃公司的ATBG鄄5药敏分析仪对临床分离的169株革兰阴性杆菌进行药敏试验,用表型确证试验检测产超广谱β鄄内酰胺酶(ESBLs)。结果:13.3%的大肠埃希菌和22.2%的肺炎克雷伯菌产ESBLs。头孢他啶、头孢噻肟、头孢曲松对产ESBLs菌株的耐药率明显高于非产ESBLs菌株(P<0.01);亚胺培南/西司他丁、哌拉西林/他唑巴坦、阿莫西林/克拉维酸对产ESBls菌株和非产ESBLs菌株的耐药率没有明显差异(P>0.05)。肠杆菌属、鲍曼不动杆菌和铜绿假单孢菌,亚胺培南/西司他丁的活性最高(敏感率100.0%),其次是哌拉西林/他唑巴坦(88.9%、78.6%和100.0%)、头孢他啶(70.4%、71.4%和90.9%)。嗜麦芽窄食单孢菌6种β鄄内酰胺类抗生素的抗菌活性均较低。结论:6种β鄄内酰胺类抗生素的抗菌活性依次是亚胺培南/西司他丁(92.9%)、哌拉西林/他唑巴坦(82.8%)、头孢他啶(69.8%)、阿莫西林/克拉维酸(62.7%)、头孢曲松(58.6%)及头孢噻肟(56.2%)。

Objective: To investigate the in vitro activity of six β-1aetams against gram nesative bacilli strains in children. Methods: The antibiotic sensitivity test of 169 clinical isolates were performed by ATB G-5 drug sensitivity analyzer of French Bio-Merieux Company. The extended spectrum β- lactamase (BSBLs) producing strains were confirmed by the NCCLS phenotypic confirmatory test. Results: 13.3% of Escherichia coli and 22.2% of Klebsiella pneumoniac produced ESBLs. The resistance rate of ceftazidime, cefotaxime, ceftriaxone on ESBLs-producing strains were significantly higher than those on non ESBLs-producing strains (P < 0.01); there was no significant difference between the resistance rate of imipenern/cilastatin, piperacillin/tazobactam, amoxicillin/clavulanic acid against ESBLs-producing and non ESBLs-producing strains (P > 0.05). Conclusion: The order of activity of the six agents was: imipenem/cilastatin (92.9%), piperacillin/tazobactam (82.8%), ceftazidime (69.8%), amoxicillin/clavulanic acid (62.7%), ceftriaxone (58.6%) and cefotaxime (56.2%).