哌拉西林-他唑巴坦/哌拉西林对小儿流感嗜血杆菌下呼吸道感染的临床疗效

[Clinical effects of piperacillin and tazobactam/piperacillin on Haemophilus influenzae lower respiratory tract infection in pediatric patients].

作者信息

Sudo Fusayo, Ishiwada Naruhiko, Hoshino Tadashi, Fukasawa Chie, Inami Yukiko, Hishiki Haruka, Takeda Nobue, Kurosaki Tomomichi, Kohno Yoichi

机构信息

Chiba Children's Hospital, Division of Infectious Diseases.

出版信息

Kansenshogaku Zasshi. 2005 Sep;79(9):637-43. doi: 10.11150/kansenshogakuzasshi1970.79.637.

DOI:10.11150/kansenshogakuzasshi1970.79.637

PMID:16248372

Abstract

OBJECTIVE

The prevalence of beta-lactamase-nonproducing ampicillin-resistant (BLNAR) Haemophilus influenzae (H. influenzae) has been increasing in recent years. Piperacillin (PIPC) is one of a few beta-lactams possessing good activity against BLNAR H. influenzae. We studied clinical efficacy of piperacillin and its beta-lactamase inhibitor, tazobactam/piperacillin (TAZ/PIPC) in children with lower respiratory tract infection caused by H. influenzae including resistance strains.

METHODS

Subjects were 20 children with lower respiratory tract infection caused by H. influenzae treated with PIPC 100mg/kg/day (7 cases) or TAZ/PIPC 125mg/kg/day (13 cases). We selected cases from which resistant H. influenzae strains might be detected. Patients received prior antimicrobial therapy within two weeks before admission, or with underlying diseases. We examined patient profiles, clinical efficacy, susceptibilities for 6 beta-lactam antibiotics [PIPC, TAZ/PIPC, ampicillin (ABPC), cefotaxime (CTX), ceftriaxone (CTRX), and meropenem (MEPM)] and analyzed 6 genotype patterns of beta-lactam resistant genes by PCR.

RESULTS

Efficacy was 7/7 in patients in PIPC group and 12/13 in patients in TAZ/PIPC group. Diminished efficacy was seen in only one case complicated with severe RSV infection. The susceptibility of all strains but one beta-lactamase producing, ABPC resistant (BLP) strain to PIPC and of all to TAZ/ PIPC was below 0.25 microg/mL. The genotype of the 15 strains isolated from the sputum on administration was as follows; beta-lactamase nonproducing, ABPC-susceptible (gBLNAS) strains were 4, gBLP strain was 1, beta-lactamase nonproducing, and ABPC-resistant (gLow-BLNAR) strains were 2, beta-lactamase nonproducing, ABPC resistant (gBLNAR) strains were 8.

CONCLUSION

PIPC and TAZ/PIPC were useful against lower respiratory tract infection caused by H. influenzae including BLNAR in children.

摘要

目的

近年来，不产β-内酰胺酶的氨苄西林耐药（BLNAR）流感嗜血杆菌（H. influenzae）的患病率一直在上升。哌拉西林（PIPC）是少数对BLNAR流感嗜血杆菌具有良好活性的β-内酰胺类药物之一。我们研究了哌拉西林及其β-内酰胺酶抑制剂他唑巴坦/哌拉西林（TAZ/PIPC）对包括耐药菌株在内的由流感嗜血杆菌引起的儿童下呼吸道感染的临床疗效。

方法

研究对象为20例由流感嗜血杆菌引起的下呼吸道感染儿童，其中7例接受100mg/kg/天的PIPC治疗，13例接受125mg/kg/天的TAZ/PIPC治疗。我们选择了可能检测到耐药流感嗜血杆菌菌株的病例。患者在入院前两周内接受过先前的抗菌治疗，或患有基础疾病。我们检查了患者的资料、临床疗效、对6种β-内酰胺类抗生素[PIPC、TAZ/PIPC、氨苄西林（ABPC）、头孢噻肟（CTX）、头孢曲松（CTRX）和美罗培南（MEPM）]的敏感性，并通过聚合酶链反应分析了β-内酰胺耐药基因的6种基因型模式。

结果

PIPC组患者的有效率为7/7，TAZ/PIPC组患者的有效率为12/13。仅1例合并严重呼吸道合胞病毒感染的患者疗效降低。除1株产β-内酰胺酶、对ABPC耐药（BLP）的菌株外，所有菌株对PIPC的敏感性以及所有菌株对TAZ/PIPC的敏感性均低于0.25μg/mL。给药时从痰液中分离出的15株菌株的基因型如下：不产β-内酰胺酶、对ABPC敏感（gBLNAS）的菌株有4株，BLP菌株有1株，不产β-内酰胺酶、对ABPC耐药（gLow-BLNAR）的菌株有2株，不产β-内酰胺酶、对ABPC耐药（gBLNAR）的菌株有8株。