常用第一、二代头孢菌素注射剂体外抗菌活性研究

Study of in vitro activity of commonly used first and second generation injection of cephalosporin

目的评价目前临床常用第一、二代头孢菌素对近年临床常见分离菌的体外抗菌活性。方法采用标准琼脂二倍稀释法;对760株细菌进行了最低抑菌浓度(MIC)测定。结果菌株主要来自2015—2016年间全国18个城市收集临床分离株。对于革兰阴性菌,第二代头孢菌素抗菌作用优于第一代头孢菌素,但对于革兰阳性需氧或厌氧菌,则第一代头孢菌素抗菌作用更优。第一代头孢菌素中,五水头孢唑林和头孢西酮抗菌作用最为全面,对甲氧西林敏感葡萄球菌、肺炎链球菌、革兰阳性菌具有较好抗菌作用,其中对甲氧西林敏感葡萄球菌的MIC90值分别为≤1mg/L和≤0.5mg/L,优于头孢拉定。对肠杆菌科细菌中不产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌、肺炎克雷伯菌以及嗜血菌、卡他莫拉菌,五水头孢唑林和头孢西酮也有很好抗菌活性,MIC_(50)值≤4mg/L,MIC_(90)值分别为≤16mg/L和≤32mg/L,优于头孢硫脒和头孢拉定。结论第一、二代头孢菌素各具特点,且同类药物中不同品种抗菌活性也不尽相同。其中五水头孢唑林抗菌作用较为全面,对革兰阳性、阴性菌均表现出较好抗菌作用,是第一代头孢菌素中临床应用最广泛的品种之一。

Objective To evaluation in vitro activity of commonly used first and second generation cephalosporins against main clinical isolated strains in recent three years. Methods Minimum inhibitory concentration (MIC) were tested by the agar dilution method. Results All of 760 stains isolated mainly from 18 cities in mainland of China between 2015 and 2016 were tested. For Gram-negative bacilli, the second generation cephalosporins had better bacteria-eliminating effects than the first generation, but the latter was more actively against Gram-positive cocci and anaerobes. Among the first generation cephalosporins, cefazolin pentahydrate and cefazedone showed all-round antibacterial activity against not only Gram-positive cocci, such as MSSA (methicillin-susceptible Staphylococcus aureus), Streptococcus pneumoniae, Peptostreptococcus, but also ESBLs (extended-spectrum beta-lactamases) negative Escherichia coli, Klebsiella pneumoniae, Haemophilus and Moraxella. MIC90 values of cefazolin pentahydrate and cefazedone for methicillin-susceptible Staphylococcus were ≤ 1mg/L and ≤ 0.5mg/L, respectively, better than cephradine. For Gram-negative above, MIC50 values of cefazolin pentahydrate and cefazedone were ≤ 4mg/L, MIC90 values were ≤ 16mg/L and ≤ 32mg/L, respectively, better than cefathiamidine and cephradine. Conclusion The first and second generation cephalosporins have their own characteristics. Different agents in the same generation also have different features. Cefazolin pentahydrate showed good and balanced in vitro activity against Gram-positive and negative stains. Therefore, it is widely used in the clinical treatment.