THE ANTIMICROBIAL SUSCEPTIBILITY OF PSEUDOMONAS-PSEUDOMALLEI - EMERGENCE OF RESISTANCE INVITRO AND DURING TREATMENT
THE ANTIMICROBIAL SUSCEPTIBILITY OF PSEUDOMONAS-PSEUDOMALLEI - EMERGENCE OF RESISTANCE INVITRO AND DURING TREATMENT
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DOI：
10.1093/jac/24.3.295
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发表时间：
1989-09-01
影响因子：
5.2
通讯作者：
WHITE, NJ
中科院分区：
文献类型：
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作者：
DANCE, DAB;WUTHIEKANUN, V;WHITE, NJ
我们测定了27种抗菌药物对211株类鼻疽假单胞菌临床菌株和10株参考菌株的体外活性。亚胺培南是测试的最具活性的抗生素，其次是哌拉西林、多西环素、阿莫西林/克拉维酸、头孢克肟、头孢他美、阿洛西林和头孢他啶，所有这些抗生素的MIC均为≤ 100。大多数菌株的浓度为2 mg/l。测定的MIC取决于所用的培养基和接种物，在一定程度上随受试抗生素类别而变化;脲基青霉素的MIC特别依赖于接种物。β-内酰胺类和环丙沙星是杀菌剂，而常规用于治疗类鼻疽病的药物（强力霉素、氯霉素、磺胺甲恶唑和甲氧苄啶）仅具有抑菌活性。对氯霉素具有高度抗性的菌株（MIC ≥256 mg/l）在7.1%的患者中出现。这些菌株是完全毒性的，并且经常显示对四环素类、磺胺甲恶唑、甲氧苄啶和环丙沙星的交叉抗性，对β-环丙沙星的敏感性矛盾地增加。内酰胺类和氨基糖苷类。在体外产生的突变体和两种参考菌株中观察到类似的耐药模式。治疗期间出现了1株头孢他啶耐药菌株，可被克拉维酸逆转。几个新的beta-内酰胺类抗生素在类鼻疽杆菌感染的治疗中具有潜在的价值。在类鼻疽治疗期间，应密切监测患者是否出现耐药菌株。
We have measured the in-vitro activity of 27 antimicrobials against 211 clinical and ten reference strains of Pseudomonas pseudomallei. Imipenem was the most active antibiotic tested, followed by piperacillin, doxycycline, amoxycillin/clavulanic acid, cefixime, cefetamet, azlocillin and ceftazidime, all of which had MICs of .ltoreq. 2 mg/l for the majority of strains. The measured MICs were dependent on the media and inocula used, to an extent which varied with the antibiotic class under test; MICs of ureidopenicillins were particularly inoculum-dependent. The .beta.-lactams and ciprofloxacin were bactericidal, whereas the agents conventionally used to treat melioidosis (doxycycline, chloramphenicol, sulphamethoxazole and trimethoprim) had bacteriostatic activity only. Strains highly resistant to chloramphenicol (MIC .gtoreq. 256 mg/l) emerged during treatment in 7.1% of patients. These strains were fully virulent, and frequently showed cross-resistance to tetracyclines, sulphamethoxazole, trimethoprim and ciprofloxacin, with paradoxical increased susceptibility to .beta.-lactams and aminoglycosides. Similar resistance patterns were seen in mutants generated in vitro and two reference strains. One strain with isolated ceftazidime resistance, reversible by clavulanic acid, emerged during treatment. Several of the new .beta.-lactam antibiotics are of potential value in the therapy of P. pseudomallei infections. Patients should be carefully monitored for the emergence of antibiotic-resistant strains during treatment of melioidosis.