Lee Ping-Yu, Chang Wen-Neng, Lu Cheng-Hsien, Lin Mei-Wen, Cheng Ben-Chung, Chien Chun-Chih, Chang Chin-Jung, Chang Hsueh-Wen
Department of Pharmacy, Chang Gung Memorial Hospital-Kaohsiung, 123 Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan.
J Antimicrob Chemother. 2003 Apr;51(4):957-62. doi: 10.1093/jac/dkg158. Epub 2003 Feb 25.
Twenty-seven adult patients were identified as having community-acquired Klebsiella pneumoniae meningitis. The K. pneumoniae isolates, collected from cerebrospinal fluid samples, were tested for in vitro antimicrobial susceptibilities. The prognostic factors of these 27 patients were also analysed. All of the third- and fourth-generation cephalosporins tested, as well as monobactam, carbapenem and ciprofloxacin, had good activities against the isolated K. pneumoniae strains. None of the clinical isolates was detected as being an extended-spectrum beta-lactamase-producing pathogen. Among the third- and fourth-generation cephalosporins, ceftizoxime, cefepime, ceftriaxone and cefotaxime had superior activities, with MIC90s about four- to eight-fold lower than those of ceftazidime and moxalactam. Mortality rates of patients classified by different antimicrobial agents were as follows: ceftazidime 38% (8/21) and cefepime 16.7% (1/6). The presence of septic shock and the initial level of consciousness at the start of appropriate antimicrobial therapy were the major determinants of survival and neurological outcomes in these 27 patients. Early diagnosis and choice of appropriate antibiotics according to antimicrobial susceptibilities may improve therapeutic outcomes.
27名成年患者被确诊患有社区获得性肺炎克雷伯菌脑膜炎。对从脑脊液样本中分离出的肺炎克雷伯菌菌株进行了体外抗菌药敏试验。还分析了这27名患者的预后因素。所有测试的第三代和第四代头孢菌素以及单环β-内酰胺类、碳青霉烯类和环丙沙星对分离出的肺炎克雷伯菌菌株均具有良好的活性。未检测到临床分离株为产超广谱β-内酰胺酶病原体。在第三代和第四代头孢菌素中，头孢唑肟、头孢吡肟、头孢曲松和头孢噻肟具有更强的活性，其MIC90比头孢他啶和拉氧头孢低约4至8倍。根据不同抗菌药物分类的患者死亡率如下：头孢他啶38%（8/21），头孢吡肟16.7%（1/6）。感染性休克的存在以及开始适当抗菌治疗时的初始意识水平是这27名患者生存和神经学转归的主要决定因素。早期诊断并根据抗菌药敏选择合适的抗生素可能会改善治疗效果。
