In vitro evaluation of cefepime and other broad-spectrum β-lactams in eight medical centers in Thailand
In vitro evaluation of cefepime and other broad-spectrum β-lactams in eight medical centers in Thailand
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DOI：
10.1016/s0732-8893(99)00123-6
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发表时间：
1999-12-01
影响因子：
2.9
通讯作者：
Jones, RN
中科院分区：
文献类型：
--
作者：
Biedenbach, DJ;Johnson, DM;Jones, RN
头孢菌素的引入对几种临床使用的β -内酰胺类抗菌药物的耐药率产生了重要影响。大多数泰国医疗中心没有记录导致侵袭性感染的新出现的耐药病原体的水平。本研究表明，采用参考质量MIC技术（Etest, AB BIODISK, Solna, Sweden），碳青霉烯类（亚胺培南）、“第四代”头孢菌素（头孢吡肟和头孢匹罗）和哌拉西林/他唑巴坦是抗革兰氏阴性杆菌（大肠埃希菌、克雷伯氏菌、肠杆菌、柠檬酸杆菌、沙雷氏菌、吲哚阳性Proteae、不动杆菌、铜绿假单胞菌、沙雷氏菌）活性最高的药物。与“第三代”头孢菌素（头孢他啶和头孢曲松）相比，对oxacillin敏感的葡萄球菌。所有菌株的活性排序为亚胺培南（2.9%）、乙非吡肟（7.7%）、哌拉西林/他唑巴坦（11.1%）、头孢他啶（13.11%）、头孢曲松（21.1%）、头孢他啶（29.9%）。大肠杆菌（15.7%）和肺炎克雷伯菌（45.6%）的广谱β -内酰胺酶产率显著。头孢吡肟和亚胺培南对大多数分离株有活性。头孢吡肟对以下几种细菌也有很好的抑制作用：1)能够产生AmpC酶的微生物；2)对oxacillin敏感的葡萄球菌；3)许多非活性革兰氏阴性杆菌。泰国抗菌素耐药性的流行率在某些常见病原体中似乎相当高，亚胺培南和头孢吡肟对90%以上的这些微生物有活性（易感和中效）。(C) 1999 Elsevier Science Inc.；
The introduction of cephalosporins has had an important impact on the resistance rates to several clinically utilized beta-lactam antimicrobial agents. Most Thailand medical centers have not documented the levels of emerging resistant pathogens causing invasive infections. This study shows using reference-quality MIC techniques (Etest, AB BIODISK, Solna, Sweden), that carbapenems (imipenem), "fourth-generation" cephalosporins (cefepime and cefpirome), and piperacillin/tazobactam were the most active agents tested against Gram-negative bacilli (Escherichia coli, Klebsiella spp., Enterobacter spp., Citrobacter spp., Serratia spp., indole-positive Proteae, Acinetobacter spp., Pseudomonas aeruginosa, and oxacillin-susceptible Staphylococcus spp. when compared to "third-generation" cephalosporins (ceftazidime and ceftriaxone). The rank order of activity for all species was imipenem (2.9% resistant) > eefepime (7.7%) > piperacillin/ tazobactam (11.1%) > ceftazidime (13.11%) > ceftriaxone (21.1%) > ceftazidime (29.9%). The incidence of extended spec -trum beta-lactamase production among E. coli (15.7%) and K. pneumoniae (45.6%) was significant. Cefepime and imipenem were active against the majority of these isolates. The activity of cefepime was also shown to be very good against, 1) organisms capable of producing AmpC enzymes, 2) staphylococci species that were susceptible to oxacillin, and 3) many strains of nonfer- mentative Gram-negative bacilli. The prevalence of antimicrobial resistance iii Thailand seems to be quite high among certain commonly encountered pathogens, and imipenem and cefepime have activity (susceptible and intermediate potency) against > 90% of these organisms. (C) 1999 Elsevier Science Inc.