头孢吡肟对产ESBL大肠埃希菌所致泌尿道感染的临床疗效观察

Clinical effect observation of cefepime for the treatment of urinary tract infection caused by ESBL-producing Escherichia coli

目的了解头孢吡肟治疗泌尿道感染的疗效以及针对大肠杆菌所致泌尿道感染的疗效，探讨头孢吡肟对产ESBL大肠杆菌泌尿道感染的临床使用及其疗效。方法收集临床诊断之泌尿道感染病人，使用头孢吡肟2．0ivgttq12h治疗，疗程7-14d；对临床分离的大肠埃希菌按照CLSI标准用纸片扩散法进行确证实验了解产超广谱B．内酰胺酶情况，并测定其MIC值。分析其所致感染用头孢吡肟治疗的临床疗效。结果共纳入泌尿系感染病人168例，疗程结束痊愈率70．83％，有效率85．12％。临床共分离大肠埃希菌81株，其中产超广谱B．内酰胺酶22株。体外对头孢吡肟的敏感率77．27％（17／22），临床治疗有效率81．82％（18／22），体外药敏与临床疗效具有一致性。结论头孢吡肟治疗泌尿道感染临床疗效好。针对体外敏感的产ESBL大肠埃希菌感染也存在确实疗效，是除碳青霉烯和头孢菌素／酶抑制剂外的另一选择。

Objective To observe the curative effect of cefepime in treating urinary tract infection and to explore the clinical usage and effect of cefepime for treatment of urinary tract infection caused by ESBL-producing Escherichia coli. Methods Patients with urinary tract infection were administered with cefepime, which dose was 2.0/day （ivgtt q12h）, for a course of 7-14d. The phenotypes of ESBL of isolated E. coli were tested by using Kirby-bauer （K-B） method as described in CLSI. And minimal inhibitory concentrations （MIC） were determined on these isolates. The clinical effect of cefepime was analyzed. Results A total of 168 patients with urinary tract infection were enrolled. At the end of the treatment, the cure rate was 70.83% and the effective rate was 85.12%. There were 81 strains of Escherichia coli had been isolated, including 22 ESBL-producing ones. The rate of susceptibility to cefepime was 77.27% （17/22） in vitro and clinical effective rate was 81.82% （18/22）. The susceptibility of E. coli to cefepime in vitro was relevant to the clinical effect in vivo. Conclusion Cefepime for the treatment of urinary tract infection could achieve better clinical efficacy. Cefepime also had curative effects on the infections caused by ESBL-producing Escherichia coli which shows susceptibility in vitro and was another treatment selection besides carbapenem and cephalosporin/enzyme inhibitors.