Emergence of cephem- and aztreonam-high-resistant Neisseria gonorrhoeae that does not produce beta-lactamase.
Emergence of cephem- and aztreonam-high-resistant Neisseria gonorrhoeae that does not produce beta-lactamase.
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DOI：
10.1007/s101560170034
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发表时间：
2001-03-01
期刊：
影响因子：
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通讯作者：
Matsumoto, T
中科院分区：
文献类型：
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作者：
Akasaka, S;Muratani, T;Matsumoto, T
关于淋球菌，国家临床实验室标准委员会(NCCLS)没有定义头孢泊辛和头孢唑酮等广谱头孢菌素的折点最低抑菌浓度(MIC)，因为这些抗生素没有耐药菌株。到目前为止，在淋球菌性尿道炎中，在使用第三代头孢菌素和氨曲南治疗后，还没有报告由耐药淋球菌菌株导致的临床失败。然而，我们在使用头孢地尼和氨曲南治疗淋球菌性尿道炎的患者中经历了两次临床失败。这两例患者分离的淋球菌对这两种药物均表现出较高的最低抑菌浓度。头孢地尼和氨曲南的MIC值分别为1和8微克/毫升，除头孢曲松的MIC值均为0.125微克/毫升外，其他β-内酰胺类药物的MIC值均高于NCCLS标准。此外，氟喹诺酮类、四环素类和红霉素对这两种菌株的MIC均高于NCCLS敏感值。这些菌株对壮观霉素敏感。在淋病奈瑟菌中，这些耐β-内酰胺的菌株的出现令人严重关注。然而，更严重的问题是，这些分离株已经对非β-内酰胺类抗菌剂产生了抗药性。在日本，头孢曲松尚未被允许用于临床治疗淋球菌感染。因此，在日本，由这些耐药淋球菌菌株引起的淋球菌性尿道炎患者应该使用头孢地嗪或壮观霉素治疗。
Regarding Neisseria gonorrhoeae, the National Committee for Clinical Laboratory Standards (NCCLS) has not defined the breakpoint minimum inhibitory concentration (MIC) for expanded spectrum cephems such as cefpodoxime and ceftizoxime, because of the absence of resistant strains to these antibiotics. To date, in gonococcal urethritis, after treatment with third generation cephems and aztreonam, clinical failures caused by resistant N. gonorrhoeae strains have not been reported. However, we experienced two clinical failures in patients with gonococcal urethritis treated with cefdinir and aztreonam. N. gonorrhoeae isolates from these two patients showed high-level MICs to these agents. The MIC of cefdinir was 1 microg/ml for both strains and that of aztreonam was 8 microg/ml for both strains, while the MICs of other beta-lactams were also higher than the NCCLS value, except for ceftriaxone, for which the MIC was 0.125 microg/ml for both strains. Moreover, the MICs of fluoroquinolones, tetracyclines, and erythromycin against these two isolates were higher than the NCCLS susceptibility value. These isolates were susceptible to spectinomycin. In N. gonorrhoeae, the emergence of these beta-lactam-resistant isolates is of serious concern. However, a more serious problem is that these isolates were already resistant to non-beta-lactam antimicrobials. In Japan, ceftriaxone has not been permitted for clinical use against gonococcal infections. Therefore, in Japan, patients with gonococcal urethritis caused by these resistant N. gonorrhoeae strains should be treated with cefodizime or spectinomycin.