CAJ | 학술논문

目的：评价β内酰胺类/β-内酰胺酶抑制剂复方及碳青霉烯类抗菌药物对产超广谱β内酰胺酶（ ESBLs ）的肺炎克雷伯杆菌、大肠埃希菌感染的临床疗效，探讨临床产ESBLs菌感染的抗生素应用。方法通过测定静滴美洛西林舒巴坦、头孢哌酮舒巴坦、哌拉西林他唑巴坦、碳青霉烯类抗生素的患者血清杀菌活性（ SBA ），分析药物疗效， SBA≥1∶8表示治疗有效。结果①对产ESBLs肺炎克雷伯菌：美洛西林舒巴坦组、头孢哌酮舒巴坦组的SBA均小于1∶8。哌拉西林他唑巴坦组SBA≥1∶8有5例，碳青霉烯类组SBA≥1∶8有8例。②对产ESBLs的大肠埃希菌：美洛西林舒巴坦组的血清杀菌活性均＜1∶8。头孢哌酮舒巴坦组的SBA≥1∶8有5例，哌拉西林他唑巴坦组SBA≥1∶8有4例，碳青霉烯类组的SBA≥1∶8有9例。结论美洛西林舒巴坦对产ESBLs的肺炎克雷伯菌及大肠埃希菌血清杀菌活性均较低，临床应用效果可能较差。对于产ESBLs菌株所致的感染，建议首选碳青霉烯类药物，避免选择β内酰胺类药物，尤其是第三代头孢菌素。若感染程度轻，可根据药敏结果选用β内酰胺/β-内酰胺酶抑制剂，对于严重感染患者，首选碳青霉烯类抗菌药物。
목적：평개β내선알류/β-내선알매억제제복방급탄청매희류항균약물대산초엄보β내선알매（ ESBLs ）적폐염극뢰백간균、대장애희균감염적림상료효，탐토림상산ESBLs균감염적항생소응용。방법통과측정정적미락서림서파탄、두포고동서파탄、고랍서림타서파탄、탄청매희류항생소적환자혈청살균활성（ SBA ），분석약물료효， SBA≥1∶8표시치료유효。결과①대산ESBLs폐염극뢰백균：미락서림서파탄조、두포고동서파탄조적SBA균소우1∶8。고랍서림타서파탄조SBA≥1∶8유5례，탄청매희류조SBA≥1∶8유8례。②대산ESBLs적대장애희균：미락서림서파탄조적혈청살균활성균＜1∶8。두포고동서파탄조적SBA≥1∶8유5례，고랍서림타서파탄조SBA≥1∶8유4례，탄청매희류조적SBA≥1∶8유9례。결론미락서림서파탄대산ESBLs적폐염극뢰백균급대장애희균혈청살균활성균교저，림상응용효과가능교차。대우산ESBLs균주소치적감염，건의수선탄청매희류약물，피면선택β내선알류약물，우기시제삼대두포균소。약감염정도경，가근거약민결과선용β내선알/β-내선알매억제제，대우엄중감염환자，수선탄청매희류항균약물。
Objective To evaluate the clinical curative effect between β-lactams/β-lactamases inhibitors and Carbapenems to ESBLs-producing Klebsiellae pneumonia and Escherichia coli and investigate the clinical application of antibiotics in the infection of ESBLs -producing bacteria.Methods To determine the serum bactericidal activity (SBA) of patients using mezlocillin/sulbactam(MLBT),cefopera-zone/sulbactam(CPZ/SBT),piperacillin/tazobactam(PIP/TAZ) and Carbapenems,the clinical application curative effect were analyzed . SBA≥1∶8 could be considered as effective in therapy .Results ①To ESBLs-producing Klebsiellae pneumonia:the SBA of MLBT groups and CPZ/SBT groups were all smaller than 1∶8.The number of SBA lager than 1∶8 in PIP/TAZ groups were five,while the Carbapenems groups were eight.②To ESBLs-producing Escherichia coli:the SBA of MLBT groups were all smaller than 1∶8.The number of SBA lager than 1∶8 in CPZ/SBT groups were five , comparing to PIP/TAZ groups were four .The number of SBA lager than 1∶8 in Carbapenems groups were nine .Conclusions In order to cure the infections of ESBLs-producing bacteria ,to choose Carbapenems antibiotics as the best therapy,avoiding of choosing β-lactams antibiotics,especially the third cephalosporin .If the gradient of infection is not severe ,choosing β-lac-tams/β-lactamases inhibitors according to drug susceptibility .If the gradient of infection is severe ,Carbapenems should be the best choice .