Xu Y, Chen M, Biedenbach D J, Deshpande L M, Jones R N
Chinese Academy Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
Diagn Microbiol Infect Dis. 1999 Oct;35(2):135-42. doi: 10.1016/s0732-8893(99)00061-9.
A surveillance study was initiated in China in 1998 in which 10 medical centers participated. The susceptibility profiles of 996 commonly occurring pathogens belonging to 10 different species groups were tested by the Etest (AB BIODISK, Solna, Sweden) against six broad-spectrum beta-lactam antimicrobial agents (cefepime, ceftazidime, ceftriaxone, imipenem, cefoperazone/sulbactam and piperacillin or oxacillin). Quality control was closely monitored and cefepime- and/or imipenem-resistant Enterobacteriaceae were referred to the reference laboratory (University of Iowa College of Medicine, Iowa City, IA) for confirmation. The isolates of Citrobacter spp. and Enterobacter spp. were generally inhibited by imipenem (100% susceptible) and cefepime (89-94%), but were more resistant to the other drugs tested (< or = 74% susceptible). The indole-positive Proteus spp. and Serratia spp. isolates were > 94% susceptible to all tested beta-lactams except piperacillin. Organisms capable of producing extended spectrum beta-lactamases (ESBLs), which included Klebsiella spp. and Escherichia coli, were most susceptible to imipenem (100%) and cefepime (> 90%). Among the non-enteric Gram-negative bacilli, all drugs were marginally active against Pseudomonas aeruginosa (MIC90s, 32-> 256 ug/mL) and the Acinetobacter spp. were rather resistant to all the compounds, except imipenem (96% susceptible). All strains of Staphylococcus spp. were susceptible to the tested antimicrobials except for ceftazidime, which had a low potency (MIC90, 12-16 micrograms/mL) against Chinese isolates with MICs that fell into the intermediate category. Cefepime, the fourth-generation cephalosporin, showed a very broad spectrum of activity against Gram-negative pathogens as well as oxacillin-susceptible Staphylococcus spp. that was comparable with imipenem (widest spectrum) and superior to the other tested beta-lactams overall. Continued monitoring of clinical strains in China seems necessary to guide chemotherapy.
1998年在中国启动了一项监测研究，有10个医学中心参与。采用Etest（AB BIODISK，瑞典索尔纳）对属于10个不同菌种组的996种常见病原体，针对六种广谱β-内酰胺类抗菌药物（头孢吡肟、头孢他啶、头孢曲松、亚胺培南、头孢哌酮/舒巴坦以及哌拉西林或苯唑西林）进行了药敏试验。严格监测质量控制，对头孢吡肟和/或亚胺培南耐药的肠杆菌科细菌送参考实验室（爱荷华大学医学院，爱荷华市，爱荷华州）进行确认。柠檬酸杆菌属和肠杆菌属的分离株通常对亚胺培南（100%敏感）和头孢吡肟（89%-94%）敏感，但对其他受试药物的耐药性更高（≤74%敏感）。吲哚阳性变形杆菌属和沙雷菌属分离株对除哌拉西林外的所有受试β-内酰胺类药物的敏感性>94%。能够产生超广谱β-内酰胺酶（ESBLs）的菌株，包括克雷伯菌属和大肠埃希菌，对亚胺培南（100%）和头孢吡肟（>90%）最为敏感。在非肠道革兰阴性杆菌中，所有药物对铜绿假单胞菌的活性都很微弱（MIC90，32->256μg/mL），不动杆菌属对所有受试化合物都有相当的耐药性，除了亚胺培南（96%敏感）。葡萄球菌属的所有菌株对受试抗菌药物敏感，除了头孢他啶，其对中国分离株的效力较低（MIC90，12-16μg/mL），MIC值属于中介类别。第四代头孢菌素头孢吡肟对革兰阴性病原体以及对苯唑西林敏感的葡萄球菌属显示出非常广泛的活性，与亚胺培南（活性谱最广）相当，总体上优于其他受试β-内酰胺类药物。持续监测中国的临床菌株似乎对于指导化疗很有必要。
