Bin Cao, Hui Wang, Renyuan Zhu, Yongzhong Ning, Xiuli Xie, Yingchun Xu, Yuanjue Zhu, Minjun Chen
Department of Pulmonary Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Dongdan, Beijing 100730, People's Republic of China.
Diagn Microbiol Infect Dis. 2006 Dec;56(4):351-7. doi: 10.1016/j.diagmicrobio.2006.06.015. Epub 2006 Aug 23.
The aim of the study was to analyze the outcome of different antibiotic treatments for bacteremia due to CTX-M-type extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. In a prospective controlled clinical study from October 2002 to April 2005, 22 consecutive cases of bacteremia due to ESBL-producing E. coli with a ceftazidime-inhibition zone diameter of > or =18 mm were studied. The Etest method was used to determine the MIC values of cefotaxime, ceftazidime, imipenem, gentamicin, and ciprofloxacin against 22 isolates of E. coli. The polymerase chain reaction and sequencing analyses were used to determine the genotypes of the ESBLs. Of these 22 episodes, 7 were treated with ceftazidime, 8 were treated with imipenem/cilastatin, and 7 were treated with cefoperazone/sulbactam after detection of bacteremia. The demographic characteristics were comparable between the 3 groups. The treatment success ratio was similar (ceftazidime 85.7%, imipenem/cilastatin 87.5%, cefoperazone/sulbactam 71.4%, P = 0.637). Difficulties arose during treatment of peritonitis caused by CTX-M-producing E. coli bacteremia. Patients with bacteremia associated with urinary tract infection or biliary tract infection had a better chance of survival. All the 22 strains of E. coli produced CTX-M ESBLs (CTX-M-3, CTX-M-14, or CTX-M-27). The MICs of ceftazidime for 22 strains of E. coli were < or =8 microg/mL. All 7 patients who received ceftazidime survived, 6 of them were cured. Treatment in one patient with a ceftazidime MIC of 2 mug/mL failed because of abdominal abscess. Treatment with ceftazidime in vivo was effective against cases of CTX-M ESBL-producing E. coli bacteremia due to urinary tract infections and biliary tract infection when the MICs of ceftazidime were < or =8 microg/mL.
本研究旨在分析不同抗生素治疗产CTX-M型超广谱β-内酰胺酶（ESBL）大肠埃希菌所致菌血症的疗效。在一项2002年10月至2005年4月的前瞻性对照临床研究中，对22例产ESBL大肠埃希菌所致菌血症且头孢他啶抑菌圈直径≥18 mm的连续病例进行了研究。采用Etest法测定头孢噻肟、头孢他啶、亚胺培南、庆大霉素和环丙沙星对22株大肠埃希菌的MIC值。采用聚合酶链反应和测序分析确定ESBL的基因型。在这22例病例中，7例在检测到菌血症后接受头孢他啶治疗，8例接受亚胺培南/西司他丁治疗，7例接受头孢哌酮/舒巴坦治疗。三组患者的人口统计学特征具有可比性。治疗成功率相似（头孢他啶组85.7%，亚胺培南/西司他丁组87.5%，头孢哌酮/舒巴坦组71.4%，P = 0.637）。产CTX-M大肠埃希菌菌血症所致腹膜炎治疗过程中出现困难。合并尿路感染或胆道感染的菌血症患者生存机会更大。22株大肠埃希菌均产CTX-M型ESBL（CTX-M-3、CTX-M-14或CTX-M-27）。22株大肠埃希菌的头孢他啶MIC值≤8 μg/mL。接受头孢他啶治疗的7例患者均存活，其中6例治愈。1例头孢他啶MIC值为2 μg/mL的患者因腹部脓肿治疗失败。当头孢他啶的MIC值≤8 μg/mL时，体内使用头孢他啶治疗产CTX-M型ESBL大肠埃希菌菌血症所致的尿路感染和胆道感染有效。
