Hoban Daryl, Felmingham David
Health Sciences Centre, Clinical Microbiology, MS673-820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada.
J Antimicrob Chemother. 2002 Sep;50 Suppl S1:49-59. doi: 10.1093/jac/dkf810.
This paper presents data relating to Haemophilus influenzae and Moraxella catarrhalis from PROTEKT (1999-2000), a surveillance study that examined the susceptibility of respiratory pathogens to current and new antibacterials. Beta-lactamase production is the principal mechanism of resistance to ampicillin and other beta-lactam antibacterials in H. influenzae and M. catarrhalis. The PROTEKT study showed that globally, the prevalence of beta-lactamase production in H. influenzae varied considerably: of 2948 isolates, 489 (16.6%) were beta-lactamase-positive [range: 1.8% (Italy) to 65% (South Korea)]. Beta-lactamase-negative, ampicillin-resistant (BLNAR) strains of H. influenzae were uncommon (<0.1%) but their very detection highlights the need for continued vigilance. Overall, few isolates of H. influenzae showed resistance to either macrolides or telithromycin. The emergence of clarithromycin-resistant strains is worrying, however, as such isolates may also show resistance to other macrolides. There was a geographical correlation between beta-lactamase production and the prevalence of resistance to chloramphenicol and tetracycline among the H. influenzae isolates. Of 1131 M. catarrhalis isolates, 92% were beta-lactamase-positive. Most isolates, however, were fully susceptible to nearly all the antibacterials tested, except ampicillin. The most active were ciprofloxacin and levofloxacin (both having MIC(90) values of 0.03 mg/L), moxifloxacin (MIC(90) 0.06 mg/L), azithromycin (MIC(90) < or = 0.06 mg/L) and telithromycin (MIC(90) 0.12 mg/L). Overall, there were no concerns in terms of resistance to fluoroquinolones for both H. influenzae and M. catarrhalis. In summary, the PROTEKT surveillance study confirmed the problem of widespread prevalence of beta-lactamase-producing strains of H. influenzae and M. catarrhalis, although these pathogens generally remain susceptible to macrolides, fluoroquinolones and the new ketolide telithromycin.
本文展示了来自PROTEKT（1999 - 2000年）研究中与流感嗜血杆菌和卡他莫拉菌相关的数据，该监测研究调查了呼吸道病原体对现有及新型抗菌药物的敏感性。β-内酰胺酶的产生是流感嗜血杆菌和卡他莫拉菌对氨苄西林及其他β-内酰胺类抗菌药物耐药的主要机制。PROTEKT研究表明，在全球范围内，流感嗜血杆菌中β-内酰胺酶产生的流行率差异很大：在2948株分离菌中，489株（16.6%）为β-内酰胺酶阳性[范围：1.8%（意大利）至65%（韩国）]。流感嗜血杆菌的β-内酰胺酶阴性、氨苄西林耐药（BLNAR）菌株并不常见（<0.1%），但其被检测到凸显了持续保持警惕的必要性。总体而言，很少有流感嗜血杆菌分离株对大环内酯类或泰利霉素耐药。然而，耐克拉霉素菌株的出现令人担忧，因为此类分离株可能也对其他大环内酯类耐药。在流感嗜血杆菌分离株中，β-内酰胺酶的产生与对氯霉素和四环素耐药的流行率之间存在地域相关性。在1131株卡他莫拉菌分离株中，92%为β-内酰胺酶阳性。然而，除氨苄西林外，大多数分离株对几乎所有测试的抗菌药物都完全敏感。活性最强的是环丙沙星和左氧氟沙星（二者的MIC(90)值均为0.03mg/L）、莫西沙星（MIC(90) 0.06mg/L）、阿奇霉素（MIC(90)≤0.06mg/L）和泰利霉素（MIC(90) 0.12mg/L）。总体而言，对于流感嗜血杆菌和卡他莫拉菌，在氟喹诺酮类耐药方面无需担忧。总之，PROTEKT监测研究证实了产β-内酰胺酶的流感嗜血杆菌和卡他莫拉菌菌株广泛流行的问题，尽管这些病原体通常对大环内酯类、氟喹诺酮类及新型酮内酯类泰利霉素仍敏感。
