In vitro comparison of combination and monotherapy for the empiric and optimal coverage of bacterial keratitis based on incidence of infection.
In vitro comparison of combination and monotherapy for the empiric and optimal coverage of bacterial keratitis based on incidence of infection.
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DOI：
10.1097/ico.0b013e318268d6f4
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发表时间：
2013-06
期刊：
影响因子：
2.8
通讯作者：
Mah FS
中科院分区：
文献类型：
--
作者：
Kowalski RP;Kowalski TA;Shanks RM;Romanowski EG;Karenchak LM;Mah FS
使用细菌性角膜炎分离株对头孢唑林/妥布霉素、头孢呋辛/庆大霉素和莫西沙星进行比较，以确定经验性治疗是否构成最佳抗菌治疗。根据角膜感染的发生率百分比，27 种金黄色葡萄球菌、16 种铜绿假单胞菌、10 种粘质沙雷氏菌、4 种陷窝莫拉氏菌、3 种流感嗜血杆菌、9 种凝固酶阴性葡萄球菌、7 种草绿色链球菌、6 种肺炎链球菌、7 种革兰氏阳性分离株和 11 种使用 E 测试测试各种革兰氏阴性分离株对头孢唑啉、妥布霉素、头孢呋辛、庆大霉素和莫西沙星的 MIC，以确定敏感性和效力。头孢呋辛/庆大霉素 (97%) 的体外覆盖率（对至少一种抗生素敏感）在统计学上与头孢唑啉/妥布霉素 (93%) 和莫西沙星 (92%) 相同 (p=0.29)。头孢呋辛/庆大霉素 (42%) 和头孢唑林/妥布霉素 (40%) 的双重覆盖（对两种抗生素敏感）相当 (p=0.77)。个体覆盖率的敏感性为莫西沙星（92%）、庆大霉素（89%）、妥布霉素（74%）、头孢唑林（58%）和头孢呋辛（52%）。庆大霉素 100%（9 中的 9 种）对耐甲氧西林金黄色葡萄球菌的覆盖效果最好。对于铜绿假单胞菌，妥布霉素比庆大霉素更有效（p=0.00001），而对于金黄色葡萄球菌，头孢唑啉比头孢呋辛更有效（p=0.0004）。尽管头孢唑啉/妥布霉素、头孢呋辛/庆大霉素和莫西沙星单一疗法之间似乎没有体外经验覆盖优势，但可能会出现效力差异，最好通过实验室研究来确定最佳治疗。
Cefazolin/tobramycin, Cefuroxime/gentamicin, and moxifloxacin were compared using bacterial keratitis isolates to determine whether empiric therapy constituted optimal anti-bacterial treatment. Based on percent incidence of corneal infection, 27 Staphylococcus aureus, 16 Pseudomonas aeruginosa, 10 Serratia marcescens, 4 Moraxella lacunata, 3 Haemophilus influenzae, 9 coagulase-negative Staphylococci, 7 Streptococcus viridans, 6 Streptococcus pneumoniae, 7 assorted Gram-positive isolates, and 11 assorted Gram-negative isolates were tested for MICs to cefazolin, tobramycin, cefuroxime, gentamicin, and moxifloxacin using E-tests to determine susceptibility and potency. The in vitro coverage (susceptible to at least one antibiotic) of cefuroxime/gentamicin (97%) was statistically equal to cefazolin/tobramycin (93%) and moxifloxacin (92%) (p=0.29). Double coverage (susceptible to both antibiotics) was equivalent (p=0.77) for cefuroxime/ gentamicin (42%) and cefazolin/tobramycin (40%). The susceptibilities of individual coverage were moxifloxacin (92%), gentamicin (89%), tobramycin (74%), cefazolin (58%), and cefuroxime (52%). Methicillin-resistant Staphylococcus aureus was best covered by gentamicin 100% (9 of 9). Tobramycin was more potent (p=0.00001) than gentamicin for Pseudomonas aeruginosa, while cefazolin was more potent (p=0.0004) than cefuroxime for Staphylococcus aureus. Although there appears to be no in vitro empiric coverage advantage between cefazolin/tobramycin, cefuroxime/gentamicin, and moxifloxacin monotherapy, potency differences may occur, and optimal treatment can best be determined with laboratory studies.