白细胞变化对抗生素治疗家兔产CTX-M-14型ESBLs细菌性腹膜炎的影响

The therapeutic effect of antibiotics on rabbit peritonitis caused by Escherichia Coli producing CTX-M-14 type ESBL

目的了解头孢他啶等几种抗生素治疗产头孢噻肟—水解酶14型(CTX-M-14型)超广谱β-内酰胺酶(ESBLs)大肠埃希菌所致的细菌性腹膜炎的治疗效果。方法在家兔腹腔内注射产CTX-M-14型ESBLs接合菌3×108cfu/ml,制备家兔细菌性腹膜炎模型。应用随机数字表法将133只制备成细菌性腹膜炎模型的家兔分为4组,1组为对照组,另3组在注射ESBLs细菌4h后分别给予头孢他啶、头孢噻肟、哌拉西林/他唑巴坦治疗。同时在抗生素治疗前,每组家兔根据白细胞总数分为白细胞升高家兔或降低家兔。密切观察兔子外周血白细胞总数和中性粒细胞百分比变化,记录兔子存活情况及大网膜病理变化。结果在头孢他啶组和哌拉西林/三唑巴坦组中,白细胞升高家兔的死亡率远低于白细胞降低家兔(P<0.01,P<0.05),而其它2治疗组比较差异无统计学意义(P>0.05),同时头孢他啶组(21.88%)、哌拉西林/他唑巴坦组家兔(23.53%)与头孢噻肟组(50.00%)、空白对照组(51.52%)的死亡率比较差异均有统计学意义(χ2=5.64,6.13,5.12,5.62,均P<0.05)。在进行抗生素治疗后,头孢他啶、哌拉西林/他唑巴坦组家兔的外周血白细胞明显恢复至基础水平,其中白细胞升高家兔恢复更快。头孢噻肟组和空白对照组家兔的白细胞仍高于基础水平。结论头孢他啶和哌拉西林/他唑巴坦对轻中度的产CTX-M-14型ESBLs大肠埃希菌腹膜炎有较好疗效。

Objective To investigate the therapeutic effect of antibiotics in rabbit peritonitis caused by Eseherichia coli producing CTX-M-14 type ESB. Methods The rabbit peritonitis model was induced by intra-abdominal injection with a mixture of 3 × 10^8 cfu/ml Escherichia coil producing CTX-M-14 type ESBL and 10% BaSO4, Four hours after the bacteria were injected, the peritonitis-induced rabbits were administered ceftazidime （100mg/kg, twice a day）, ceftaxime （100mg/kg, twice a day） and piperacillin/tazobactam （225mg/kg, every 8h） intramuscularly respectively. The fourth group did not give any therapy as a control. Before treatment the leucocytes were counted in each group, during the experiments the leucocyte counts and percentage of neutrophil were closely observed. The time of death was recorded and autopsy was performed immediately, the great omentum was examined pathologically. Results In ceftazidime-treated group and piperacillin/tazobactam-treated group, the mortality of rabbits with high leucocyte count were significantly lower than that of rabbits with low leucecyte count （P = 0.007,0.043）. But in the other two groups, there were no differences. Compared with the mortality of ceftaxime-treated group （50.00 % ）and control group （51.52 % ）, the mortality of ceftazidime-treated group （21.88%）and piperacillin/tazobactam-treated group （23.53%） were significantly lower （x^2= 5.64, 6.13, 5.12, 5.61, P〈0.05）. In addition, the leucocyte counts of the ceftazidime-treated group and piperacillin/tasobactam-treated groups were recovered normal after treatment, especially for rabbits with high leucocyte, while those of the ceftaxime group and control group were remeined high. Conclusions The ceftazidime and piperacillin/tazobactam have good therapeutic effect in peritonitis caused by Escherichia coli producing CTX-M-14 type ESBL.