对国内常用头孢菌素的评价

AN EVALUATION ON CEPHALOSPORINS USED IN CHINA

过去工作表明.北京地区临床分离产酶阴性杆菌占65.5%.我所抗感染病房对确诊为院内感染病人致病菌调查证明大多为多重耐药阴性杆菌,说明控制阴性杆菌引起的严重感染必须选用抗阴性杆菌作用强大并且高度耐酶的抗生素.本文就我所过去和近期对头孢菌素类的抗菌作用、β-内酰胺酶稳定性研究及本院临床对重症感染使用头孢噻甲羧肟治疗结果等,对头孢菌素类进行比较.从列举的实验结果证实头抱噻甲羧肟是抗绿脓杆菌最强的抗生素,MIC_(90)为4mg/L.敏感菌株百分率为94.4%,头孢哌酮的相应结果分别分16mg/L与83.8%.研究结果还证实绿脓杆菌对头孢噻甲羧肟的耐药率较其他抗绿脓杆菌抗生素为低,发展较慢.对28例严重感染用头孢噻甲羧肟治疗,有效率为82.14%.讨论了头孢菌素类的合理使用,并对头孢氨呋肟与头孢哌酮抗阴性杆菌作用进行比较.建议重症耐药阴性杆菌感染特别是重症绿脓杆菌感染应及时使用头孢噻甲羧肟治疗,中度严重的耐药阴性菌感染首选头孢氨呋肟治疗.

Our previous work showed that the percentage of β-lactamase-pro-ducing Gram-negative rods isolated from general hospitals in Beijing was as high as65.5%. In 1987, a programme on multiple drug-resistant bacteria surveillance was conductedin our anti-infection research ward.During an 8-month period, 55 isolates or Gram-neg-ative bacilli were collected from patients considered as having hospital infections. 18 of the55 strains were resistant to seven antibioties tested, including ampicillin, carbenicillin,furbenicillin, cefazolin, gentamicin, tobramycin, and chloramphenicol; but 17 of the18 strains were still highly sensitive to ceftazidime, the corresponding number or sensitivestrains of cefoperazone, cefotaxime and ceftriaxone were 8/18, 11/18, and 15/18, respectively.Our research date obtained in 1987 from a comparative in-vitro activity ofcephalosporins against 1098 pathogens isolated from patients in Beijing also proved thatceftazidime is the best antipseudomonas antibiotic and onc of the best new cephalosporinsagainst other Gram-negative rods.The results showed that the MIC_(90), MIC_(50), I_(50) and the percentage or susceptible strains of ceftazidime against Pseudomonas aeruginosa were 4,2, 1.96 and 94.4%, respectively, while the corresponding data or cefoperazone were 16,4, 8.96 and 83.8%, respectively. The results or in vitro activity obtained in 1987 have beencompared with the data obtained in 1985-1986.The results showed that the rate or resist-ance of Ps. aeruginosa to ceftazidime is the lowest among the third-generationcephalosporins and other antipseudomonal antibiotics tested. The rising incidence of multi-resistant Gram-negative bacteria isoalted in hospitalshas become a big problem in clinics. It is highly necessary to use enzyme-stablecephalosporins with strong activity against Gram-negative bacilli in the treatment of severeinfections caused by Gram-negative resistant bacilli. particularly byPs. aeruginosa. Ceftazidime has been suggested to be used as soon as possible in that situa-tion. A survey or the amount of cephalosporins used from January 1987 to May 1988 in theFirst Teaching Hospital of the Beijing Medical University showed that the percentage ofthird-generation cephalosporins used is going up obviously and the amount of ceftazidimeused was 49.1% in 1987 and 59.4% in 1988 or the amount or third-generationcephalosporins. Clinical results showed that in a period of five months (January-May,1988), altogether Fifty very severe hospital infections were treated. With ceftazidime in ourhospital. Most of patients recovered satisfactorily according to the above consultations, bytreating with ceftazidime as soon as possible. Some cases failed because of startingceftazidime therapy too late. Our results also suggested that for most moderate severe infec-tions caused by E.coli, Klebsiella spp., Salmonelia typhi, Enterobacter cloacae, Shigelladysenteria, cefuroxime will be the best choice. The antibacterial activity or cefuroximeagainst Klebsiella spp., Shigella dysenteria was similar to that or cefoperazone, andcefuroxime showed slightly better aetivity against E.coli, salmonella typhi and Enterobact-er cloacae than that of cefoperazone.