头孢泊肟酯与头孢克肟对儿童社区获得性肺炎常见病原菌体外抗菌活性的比较

Comparison of in vitro antibacterial activities of Cefpodoxime proxetil and Cefixime against common pathogens of community acquired pneumonia in children

目的比较头孢泊肟酯和头孢克肟对儿童社区获得性肺炎常见病原菌的体外抗菌活性,为指导临床合理应用抗生素提供依据。方法回顾性选择2018年6月至2019年10月在江西省儿童医院住院的100例社区获得性肺炎患儿感染的病原菌,按美国临床和实验室标准协会(CLSI)的推荐,采用宏量肉汤稀释法(试管)分别测定病原菌对头孢泊肟酯和头孢克肟的敏感性及耐药性,并进行比较。结果1.头孢泊肟酯对链球菌属、流感嗜血杆菌、卡他摩拉菌的50%受试菌株最低抑菌浓度(MIC50)、90%受试菌株最低抑菌浓度(MIC90)值均在敏感范围内,表现出较强的抑菌作用。头孢克肟对肺炎链球菌和流感嗜血杆菌的MIC50在敏感范围内,而对两者的MIC90值则表现为耐药。剩余细菌对2种药物均表现出不同程度的耐药性。2.头孢泊肟酯对肺炎链球菌和流感嗜血杆菌的最低杀菌浓度(MBC)范围明显低于头孢克肟,表现出较强的杀菌活性。这2种药物对卡他摩拉菌、β化脓性链球菌、无乳链球菌的50%受试菌株最低杀菌浓度(MBC50)、90%受试菌株最低杀菌浓度(MBC90)值均仍在MIC敏感范围内,均表现出较强的杀菌作用;剩余细菌对2种药物则均表现出不同程度的耐药性。3.入选的100株病原菌对头孢泊肟酯、头孢克肟的敏感率分别为70.00%(70/100株)、57.00%(57/100株),耐药率分别为22.00%(22/100株)、39.00%(39/100株),2种药物的药物敏感性比较差异有统计学意义(χ^2=7.40,P=0.03)。结论头孢泊肟酯对儿童社区获得性肺炎常见病原菌有较高的敏感性,可作为儿童呼吸道细菌感染初始经验性治疗的药物选择,也可作为儿童常见呼吸道细菌感染抗生素序贯疗法口服的适宜选择。

Objective To compare the in vitro antibacterial activities of Cefpodoxime proxetil and Cefixime against common pathogens of community acquired pneumonia in children,and to provide basis for guiding the rational use of antibiotics in clinical practice.Methods The pathogens of 100 cases of community acquired pneumonia in Children's Hospital of Jiangxi Province from June 2018 to October 2019 were analyzed retrospectively.The sensitivity and resis-tance of these pathogens to Cefpodoxime proxetil and Cefixime were measured separately by the broth dilution method(tube)recommended by the Clinical&Laboratory Standards Institute(CLSI),and the results were compared.Results(1)The 50% minimum inhibitory concentration(MIC50)and MIC90 values of Cefpodoxime proxetil to Streptococcus,Haemophilus influenzae and Moraxella catarrhalis were all within the sensitive range,showing that Cefpodoxime proxetil had a strong antibacterial effect.The MIC50 values of Cefixime to Streptococcus pneumoniae and Haemophilus influenza were within the sensitive range,while the MIC90 values showed that these two types of bacteria were resistant to Cefixime.The remaining bacteria were resistant to Cefpodoxime proxetil and Cefixime to varying degrees.(2)The minimum bactericidal concentration(MBC)ranges of Cefpodoxime proxetil to Streptococcus pneumoniae and Haemophilus influenzae were significantly lower than those of Cefixime to these two types of bacteria,indicating that Cefpodoxime proxetil had stronger bactericidal activities than Cefixime.The MBC50 and MBC90 values of the two drugs to Moraxella catarrhalis,β-Streptococcus pyogenes and Streptococcus lactis were still within the sensitive range of MIC,suggesting that both drugs had a strong bactericidal effect.The remaining bacteria showed resistance to the two drugs to varying degrees.(3)The sensitivity rates of 100 selected pathogens to Cefpodoxime proxetil and Cefixime were 70.00%(70/100 strains)and 57.00%(57/100 strains),respectively.The resistance rates of the 100 pathogens to the two drugs were 22.00%(22/100 strains)and 39.00%(39/100 strains),respectively,and the difference between the two groups was statistically significant(χ^2=7.40,P=0.03).Conclusions Cefpodoxime proxetil has high sensitivity to common pathogens of children with community-acquired pneumonia,so it can be used as the initial empirical treatment of respiratory tract bacterial infection in children.It is also an appropriate sequential antibiotic therapy for common respiratory tract bacterial infection in children.