赵声远,肖淑珍,项瑾,顾飞飞,韩立中,倪语星,王辉,王占伟,刘国驹
ZHAO Shengyuan,XIAO Shuzhen,XIANG Jin,GU Feifei,HAN Lizhong,NI Yuxing,WANG Wei,WANG Zhanwei,WANG Ting

• 1:临床微生物科上海交通大学医学院附属瑞金医院
• 2:临床医学院检验系上海交通大学医学院附属瑞金医院
• 3:北京大学人民医院
• 4:湘北威尔曼制药股份有限公司

摘要(Abstract)：

目的评估头孢噻肟/舒巴坦(CTX/SBT,2∶1)、和头孢哌酮/舒巴坦(CPZ/SBT,2∶1)对引起血流感染主要革兰阴性杆菌的体外抑菌效应。方法收集引起血流感染的产超广谱β内酰胺酶(extended-spectrumβ-lactamases,ESBLs)大肠埃希菌、非产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌、非产ESBLs肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌各50株,用琼脂平板二倍稀释法测定CTX/SBT、CPZ/SBT、头孢噻肟(CTX)、头孢曲松(CRO)、头孢哌酮(CPZ)的最低抑菌浓度(MIC)。结果复方制剂的抗菌活性均优于单药应用,可使MIC50的降幅达4~16倍;其中CTX/SBT的抑菌效果优于其他抗生素和CPZ/SBT复方,尤其是对产ESBLs的大肠埃希菌和肺炎克雷伯菌,其MIC50可从单用的128~256μg/m L降至16~32μg/m L。结论三代头孢舒巴坦复方制剂对引起血流感染的主要革兰阴性杆菌的体外抗菌效果均优于单用药物,其中CTX/SBT的抑菌效果最好,尤其是对于产ESBLs菌株。
OBJECTIVE To evaluate the bacteriostasis effect of cephalosporin / sulbactam( CTX / SBT,2 ∶ 1) and cefoperazone /sulbactam( CPZ / SBT,2 ∶ 1) compound preparations to gram negative bacilli causing bloodstream infections in vitro. METHODS Fifty isolates of extended-spectrum β-lactamases( ESBLs) producing Escherichia coli,non-ESBLs producing Escherichia coli,ESBLs producing Klebsiella pneumoniae,non-ESBLs producing Klebsiella pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii were collected respectively,and then the minimum inhibitory concentrations( MICs) of CTX / SBT,cefoperazone / sulbactam( CPZ /SBT),CTX,CRO and CPZ were determined by the agar dilution method. RESULTS The antibacterial activity of compound preparations were better than antibiotics used alone,producing a 4-16 times drop in MIC50. Among them,CTX / SBT was better than the other compound preparations,especially for ESBLs producing Escherichia coli and Klebsiella pneumoniae,the MIC50 of CTX / SBT were dropped to 16-32 μg / m L,while the MIC50 of CTX alone were 128-256 μg / m L. CONCLUSION Third-generation cephalosporin /sulbactam compound preparations showed higher antibacterial activity against gram negative bacilli causing bloodstream infections than antibiotics alone,and CTX / SBT was better than the other compound preparations,especially for ESBLs producing isolates.

关键词(KeyWords)： 头孢噻肟/舒巴坦;血流感染;革兰阴性杆菌;体外抗菌活性
cephalosporin / sulbactam compound preparations;bloodstream infections;gram negative bacilli;in vitro antibacterial activity

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 赵声远,肖淑珍,项瑾,顾飞飞,韩立中,倪语星,王辉,王占伟,刘国驹
ZHAO Shengyuan,XIAO Shuzhen,XIANG Jin,GU Feifei,HAN Lizhong,NI Yuxing,WANG Wei,WANG Zhanwei,WANG Ting

参考文献(References)：

• [1]李光辉,朱德妹,汪复,等.2011年中国CHINET血培养临床分离菌的分布及耐药性[J].中国感染与化疗杂志,2013,13(4):241-247.
• [2]陈新谦,金有豫,汤光.新编药物学[M].第17版.北京:人民卫生出版社,2011,51.
• [3]Babic M,Huier AM,Bonomo R.What’s news in antibiotic resistance?Focus on beta-lactamases[J].Drug Resistance Updates,2006,9:142-156.
• [4]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing,twentieth informational supplement,M100-S23[S].CLSI,2013.
• [5]钟运华,何林,周克元,等.超广谱β-内酰胺酶研究进展[J].国际检验医杂志,2008,29(3):252-257.
• [6]Buynak JD.Understanding the longevity of the beta-lactam antibiotics and of antibiotic/beta-lactanase inhibitor combination[J].Biochem Pharmacal,2006,71(7):930-940.
• [7]侯盼飞,应春姝.鲍曼不动杆菌对-内酰胺类抗生素耐药机制的研究进展[J].上海交通大学学报(医学版),2010,30(1):98-103.
• [8]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing,twentieth informational supplement,M100-S20[S].CLSI,2010.
• [9]Bourneton O,Mutel T,Heranney D,et al.Incidence of hospital-acquired and community-acquired bloodstream infections in the university of strasbourg Hospital,France,between 2005 and 2007[J].Pathol Biol(Paris),2010,58(1):29-34.
• [10]陈旭辉,罗文涛,马满玲.不同配比头孢噻肟/舒巴坦对180株临床分离菌的体外抗菌活性[J].中国药师,2012,15(8):1113-1116.
• [11]刘国成,柯红,刘刚,等.头孢哌酮及不同配比头孢哌酮/舒巴坦的体外抗菌活性研究[J].中国药业,2007,16(7):3-4.
• [12]冯群岭,李系帆,顾宜,等.头孢噻肟/舒巴坦复方新药对产酶革兰阴性杆菌体外抑菌效应研究[J].现代检验医学杂志,2008,23(1):43-45.
• [13]孙明杰,吕华冲,邓桂兴,等.注射用头孢噻肟舒巴坦钠2:1[J].中国新药杂志,2008,17(7):613-617.
• [14]王勋松,徐长辉,袁水斌,等.头孢哌酮/舒巴坦对常见革兰阴性杆菌的体外抗菌作用[J].实验与检验医学,2012,30(6):595-596.