3种碳青霉烯抗生素体外抗菌活性及对肺部感染的疗效观察

A comparative study in vitro of antibacterial activity of 3 carbapenem antibiotics and their therapeutic efficacy against pulmonary infection

目的了解碳青霉烯类抗生素对临床常见致病菌的体外抗菌活性并评价其治疗肺部感染的疗效.方法采用琼脂二倍稀释法测定帕尼培南/倍他米隆、亚安培南/西司他丁、美罗培南对242株临床分离菌的最低抑菌浓度(min-imal inhibitory concentration,MIC),及对部分菌株的最低杀菌浓度(minimal bactericidal concentration,MBC).分别对20例、18例及16例肺部感染患者使用帕尼培南/倍他米隆、亚安培南/西司他丁、美罗培南500mg加生理盐水100 ml,12 h 1次,静脉点滴,疗程3～7 d.结果三者对临床常见的G-和G+致病菌都有很强的抗菌活性,作用相仿.帕尼培南/倍他米隆对G+菌的抗菌活性最强,美罗培南对G-菌的抗菌活性较其余二者强2～8倍.经三者治疗后细菌转阴率分别为78%、89%及94%;治疗肺部感染的有效率分别为75%、83%及88%.结论三者对临床常见致病菌的体外抗菌活性强,抗菌作用相仿,对肺部感染均有较好疗效,安全性好.

Objective To investigate the antimicrobial activity of panipenem/betamipron, imipenem/cilastatin and meropenem against clinical isolates in vitro and to estimate their therapeutic effects on pulmonary infection. Methods The minimal inhibitory concentrations (MICs) of panipenem/betamipron, imipenem/cilastatin and meropenem to 242 clinical isolates were determined by means of agar dilution method and their minimal bactericidal concentrations (MBCs) to some clinical isolates were determined. Twenty, eighteen and sixteen cases with pulmonary infection were treated with intravenous drip of panipenem/betamipron, imipenem/cilastatin and meropenem at a dose of 500 mg/12 h for 3 to 7 d, respectively. Meanwhile, bacteria culture was conducted and the efficacy of the drugs was consecutively evaluated. Results Panipenem/betamipron, imipenem/cilastatin and meropenem were all powerful antibiotic agents against the broad antibacterial spectrum of both gram-positive and gram-negative bacteria in clinical isolates. The in vitro antimicrobial activity of the three carbapenems was similar. The bactericidal effects of panipenem/betamipron on gram-positive bacteria were superior as compared with that of imipenem/cilastatin and meropenem. The antimicrobial activity of meropenem to gram-negative bacteria was superior as compared with that of the other two in vitro. The eradication rate of bacteria treated with panipenem/betamipron, imipenem/cilastatin and meropenem was 80.9%, 89% and 94%, respectively, and their effective healing rate was 75%, 83% and 88%, respectively. No severe adverse reaction was observed. No statistical differences among three groups were observed. Conclusion Panipenem/betamipron, imipenem/cilastatin and meropenem are all powerful antibiotic agents against the broad antibacterial spectrum of both gram-positive and gram-negative bacteria from clinical isolates. The three carbapenems have similar antimicrobial activity in vitro and are effective and safe in treating pulmonary infection.