Pfaller M A, Korten V, Jones R N, Doern G V
Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA.
Diagn Microbiol Infect Dis. 1999 Sep;35(1):65-73. doi: 10.1016/s0732-8893(99)00054-1.
From March through July 1997, a nine laboratory surveillance project was initiated in Turkey to monitor the potency and spectrum of seven broad-spectrum antimicrobial agents (cefepime, ceftazidime, cefotaxime, imipenem, aztreonam, cefoperazone/sulbactam, and ticarcillin/clavulanate) tested against approximately 100 organisms (average 82; range 70 to 95 isolates) per participant center (736 strains). Eleven groups of organisms were tested by the Etest method (AB BIODISK, Solna, Sweden) with results validated by concurrent quality control strain analysis. Results from all centers were tabulated and 91.1% of quality assurance tests were within ranges recommended by the National Committee for Clinical Laboratory Standards. Among the seven beta-lactam-class drugs tested, imipenem and cefepime were the most active beta-lactams tested against all isolates. Overall, the rank order of susceptibility of the seven agents was imipenem > cefepime > cefoperazone/sulbactam > ceftazidime > cefotaxime > aztreonam > ticarcillin/clavulanate. Both cefepime and imipenem were active against ceftazidime-resistant strains of Enterobacteriaceae as well as against Streptococcus spp. and oxacillin-susceptible Staphylococcus aureus. Resistance phenotypes consistent with extended spectrum beta-lactamases were documented among Escherichia coli and Klebsiella spp., and profiles consistent with stably derepressed Bush-Jacoby-Mederios group 1 (Amp C) cephalosporinases were common among Enterobacter spp., Citrobacter spp., and Serratia spp. These data should be used to guide empiric therapy with beta-lactams in Turkey, and additionally will provide a reference statistical baseline to which future national studies of drugs in this class can be compared.
1997年3月至7月，土耳其启动了一项由九个实验室参与的监测项目，以监测七种广谱抗菌药物（头孢吡肟、头孢他啶、头孢噻肟、亚胺培南、氨曲南、头孢哌酮/舒巴坦和替卡西林/克拉维酸）对每个参与中心约100种微生物（平均82种；范围为70至95株分离菌）的抗菌效力和抗菌谱（共736株菌株）。采用Etest方法（AB BIODISK，瑞典索尔纳）对11组微生物进行检测，同时通过质量控制菌株分析验证结果。汇总所有中心的结果，91.1%的质量保证检测结果在国家临床实验室标准委员会推荐的范围内。在测试的七种β-内酰胺类药物中，亚胺培南和头孢吡肟是对所有分离菌活性最强的β-内酰胺类药物。总体而言，这七种药物的敏感性排序为：亚胺培南＞头孢吡肟＞头孢哌酮/舒巴坦＞头孢他啶＞头孢噻肟＞氨曲南＞替卡西林/克拉维酸。头孢吡肟和亚胺培南对产头孢他啶酶的肠杆菌科菌株、链球菌属以及对苯唑西林敏感的金黄色葡萄球菌均有活性。在大肠杆菌和克雷伯菌属中记录到了与超广谱β-内酰胺酶一致的耐药表型，而与稳定去阻遏的Bush-Jacoby-Mederios 1组（Amp C）头孢菌素酶一致的谱型在肠杆菌属、柠檬酸杆菌属和沙雷菌属中很常见。这些数据应用于指导土耳其β-内酰胺类药物的经验性治疗，此外还将提供一个参考统计基线，以便与该类药物未来的全国性研究进行比较。
