Essack S Y
School of Pharmacy and Pharmacology, University of Durban-Westville, South Africa.
FEMS Microbiol Lett. 2000 Sep 15;190(2):181-4. doi: 10.1111/j.1574-6968.2000.tb09283.x.
A review of antibiotic options for the treatment of infections caused by extended-spectrum beta-lactamase-producing isolates is presented. The use of the third-generation cephalosporin, cefotaxime, for infections caused by isolates producing ceftazidimase-type extended-spectrum beta-lactamases is controversial, despite in vitro susceptibility to the antibiotic in many instances. The fourth-generation cephalosporin, cefipime, although active against most extended-spectrum beta-lactamases, is reported to show a marked inoculum effect. The cephamycins, such as cefoxitin. are generally effective against Enterobacteriaceae producing TEM- and SHV-derived extended-spectrum beta-lactamases, but Klebsella pneumoniae strains are prone to cephamycin resistance as a result of porin loss. The use of beta-lactamase inhibitor combinations is variable. Sulbactam is less effective than clavulanate for the inhibition of SHV-derived extended-spectrum beta-lactamases and a marked inoculum effect has been noted, while the efficacy of tazobactam against SHV-derived extended-spectrum beta-lactamase producers is controversial. Furthermore, extended-spectrum beta-lactamases are often encoded by multi-resistant plasmids carrying genes conferring resistance to aminoglycosides, chloramphenicol, sulfonamides, trimethoprim and other antimicrobials, severely limiting even alternative therapies. Extensive susceptibility testing before the institution of antibiotic therapy is thus vital.
本文综述了治疗产超广谱β-内酰胺酶菌株所致感染的抗生素选择。对于产头孢他啶酶型超广谱β-内酰胺酶的菌株所致感染，使用第三代头孢菌素头孢噻肟存在争议，尽管在许多情况下该菌株对这种抗生素在体外敏感。第四代头孢菌素头孢吡肟虽然对大多数超广谱β-内酰胺酶有活性，但据报道其存在明显的接种量效应。头霉素类，如头孢西丁，通常对产TEM型和SHV型超广谱β-内酰胺酶的肠杆菌科细菌有效，但肺炎克雷伯菌菌株由于孔蛋白缺失容易对头霉素耐药。β-内酰胺酶抑制剂联合用药的效果不一。舒巴坦对抑制SHV型超广谱β-内酰胺酶的效果不如克拉维酸，且已注意到明显的接种量效应，而他唑巴坦对产SHV型超广谱β-内酰胺酶菌株的疗效存在争议。此外，超广谱β-内酰胺酶通常由携带赋予对氨基糖苷类、氯霉素、磺胺类、甲氧苄啶和其他抗菌药物耐药性基因的多重耐药质粒编码，这严重限制了甚至替代疗法的应用。因此，在开始抗生素治疗前进行广泛的药敏试验至关重要。
