选择β-内酰胺类药物实验室预报药的探讨

目的:根据耐药表型及相应的耐药机制进行β-内酰胺类药物实验室预报组合的探讨。方法:4种常见革兰氏阴性杆菌用KB检测14种β-内酰胺类抗生素,用Nitrocefin纸片相邻等方法检测各类β-内酰胺酶。结果:大肠埃希菌和肺炎克雷伯菌中产生各类β-内酰胺酶、超广谱β-内酰胺酶占81.8％;铜绿假单胞菌66.7％产诱导型β-内酰胺酶。其耐药与膜通透性密切相关;鲍曼不动杆菌的耐药率最高,以膜通透性改变为主,但加青霉烷砜作为酶抑制剂使耐药率明显下降。结论:大肠埃希菌、肺炎克雷伯菌宜选各类β-内酰胺酶的最佳底物药及其加酶抑制剂的药物作预报药:铜绿假单胞选哌拉西林头孢哌酮、头孢哌酮/青霉烷砜、头孢他啶外须加诱导酶试验;鲍曼不动杆菌应包括加青霉烷砜的抗菌药物。

The Selection of β-lactam Antibiotics as Laboratory Antibiotic Predictors

Objective: To select suitable beta-lactam antibiotics as laboratory antibiotics predictor according to resistance pheno-types and corresponding mechanisms.Methods: Four gram-negative bacterias were tested by fourteen beta-lactam antibiotics with K-B method. Results: Positive rates of the beta-lactamases and the extended spectrum beta-lactamase were 81.8% in E.coli and K. pneumonia . The rate of induction of beta- lactamase in P. aeruginose was 66.1% . The resistance was closely corrected with cell permeability of membrane,rate of A.beumanni was the highest as decreasing cell permeability. The resistant rate was obviously decreased using sulbactam. Conclusion: Antibiotics of optimum substrates and enzyme inhibitors should be tested for E. coli and K. pneumonia. For P. aeruginose piperacillin cefoperaxon, cefoperazon/sulbactam and ceftazidime should be selected and the induction beta-laclamase test should be performed. Antibiotics for A.baumanii should include sulbactam complexes.