Lewis M T, Yamaguchi K, Biedenbach D J, Jones R N
Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA.
Diagn Microbiol Infect Dis. 1999 Dec;35(4):307-15. doi: 10.1016/s0732-8893(99)00120-0.
An antimicrobial resistance surveillance study in Japan is presented representing the second year (Phase II) results from 22 medical centers. Each participant laboratory tested (Etest, AB BIODISK, Solna, Sweden) 100 organisms, 10 strains each from 10 species groups including Escherichia coli, Klebsiella spp., Enterobacter spp., Citrobacter spp., indole-positive Proteae, Serratia spp., Acinetobacter spp., Pseudomonas aeruginosa, and oxacillin-susceptible Staphylococcus aureus and coagulase-negative staphylococci. Generally only modest variations in the activity of the studied broad-spectrum beta-lactams was observed compared to the study a year before. Specifically, extended spectrum beta-lactamase (ESBL) rates in E. coli increased (2.9 to 8.1%), but the ESBL rate in Klebsiella spp. fell (8.6 to 5.0%). Overall the resistance to the beta-lactams varied from a 4.7% decrease (ceftazidime as a consequence of a modified staphylococcal breakpoint criteria) to a 1.0% increase (cefepime, not significant). The rank order of spectrums in 1998 only changed for cefoperazone-sulbactam (6.1% resistance) that was active against more strains than cefpirome (6.8% resistance). The overall spectrum rank order for the 1998 Japan sample (% resistance) was: cefepime (3.2%) > imipenem (4.1%) > cefoperazone-sulbactam (6.1%) > cefpirome (6.8%) > ceftazidime (8.4%) > piperacillin (19.9%). As with a similar study in 1997, imipenem-resistant isolates of P. aeruginosa and Serratia spp. were discovered with metalloenzymes, usually found in the same medical centers. These results demonstrate the continued in vitro activity and potential sustained clinical efficacy of several broad-spectrum beta-lactams in Japan. Rapid emergence of new or novel resistance were not wide spread using a precise quantitative MIC system. Continued surveillance in this nation would be prudent to document the activity of this clinically valuable class of safe, antimicrobial agents.
本文展示了一项日本的抗菌药物耐药性监测研究，呈现了来自22个医疗中心的第二年（第二阶段）结果。每个参与实验室使用（Etest，AB BIODISK，瑞典索尔纳）检测了100株菌株，分别来自10个菌种组，每组10株，包括大肠杆菌、克雷伯菌属、肠杆菌属、柠檬酸杆菌属、吲哚阳性变形杆菌、沙雷菌属、不动杆菌属、铜绿假单胞菌、对苯唑西林敏感的金黄色葡萄球菌和凝固酶阴性葡萄球菌。与前一年的研究相比，观察到所研究的广谱β-内酰胺类药物的活性总体变化不大。具体而言，大肠杆菌中的超广谱β-内酰胺酶（ESBL）发生率上升（从2.9%升至8.1%），但克雷伯菌属中的ESBL发生率下降（从8.6%降至5.0%）。总体而言，对β-内酰胺类药物的耐药性变化范围为下降4.7%（由于葡萄球菌断点标准的修改，头孢他啶）至上升1.0%（头孢吡肟，无显著差异）。1998年的谱序仅头孢哌酮-舒巴坦（耐药率6.1%）发生了变化，其对更多菌株有效，优于头孢匹罗（耐药率6.8%）。1998年日本样本的总体谱序（耐药率%）为：头孢吡肟（3.2%）>亚胺培南（4.1%）>头孢哌酮-舒巴坦（6.1%）>头孢匹罗（6.8%）>头孢他啶（8.4%）>哌拉西林（19.9%）。与1997年的类似研究一样，在铜绿假单胞菌和沙雷菌属中发现了产金属酶的亚胺培南耐药菌株，这些菌株通常出现在相同的医疗中心。这些结果证明了几种广谱β-内酰胺类药物在日本持续的体外活性和潜在的持续临床疗效。使用精确的定量MIC系统，新的或新型耐药性的快速出现并未广泛传播。在该国持续进行监测将是谨慎的做法，以记录这类具有临床价值的安全抗菌药物的活性。
