Glupczynski Y, Huang T-D, Berhin C, Claeys G, Delmée M, Ide L, Ieven G, Pierard D, Rodriguez-Villalobos H, Struelens M, Vaneldere J
Cliniques universitaires UCL de Mont-Godinne, Laboratoire de Microbiologie, 5530, Yvoir, Belgium.
Eur J Clin Microbiol Infect Dis. 2007 Nov;26(11):777-83. doi: 10.1007/s10096-007-0370-9.
Temocillin is a narrow spectrum penicillin with high stability to most beta-lactamases including AmpC types and extended-spectrum types (ESBLs). We have analysed its in vitro activity against 652 clinical isolates of Enterobacteriaceae prospectively collected from patients hospitalised in intensive care units at seven different university hospitals in Belgium in 2005. Strains were screened for ESBL production using cefotaxime and ceftazidime screen agar plates and by double ESBL E-tests. The MIC of temocillin and of five comparators was determined using the E-test method. ESBLs were characterized at one central laboratory by isoelectric focusing, PCR for bla genes of the SHV, TEM, and CTX-M families, and by DNA sequencing. The prevalence of ESBL-producing Enterobacteriaceae averaged 11.8% and ranged between 3.0 and 29% in the different hospitals. Meropenem exhibited the highest in vitro activity overall (mode MIC 0.064 microg; MIC(90); 0.19 microg/ml), whereas ceftazidime (MIC(90) > 256 microg/ml) and ciprofloxacin (MIC(90) > 32 microg/ml) scored the worst. Temocillin was active against more than 90% of the isolates including most AmpC- and ESBL-producing isolates. These data indicate the well preserved activity of temocillin over the years against Enterobacteriaceae and show the wide variation in prevalence of ESBL-producing Enterobacteriaceae isolates in Belgian intensive care units. Prospective clinical studies are, however, needed to validate the usefulness of temocillin in the treatment of microbiologically documented infections caused by ESBL- and/or AmpC- overproducing nosocomial Enterobacteriaceae pathogens.
替莫西林是一种窄谱青霉素，对包括AmpC型和超广谱型（ESBLs）在内的大多数β-内酰胺酶具有高度稳定性。我们前瞻性地分析了其对2005年从比利时七家不同大学医院重症监护病房住院患者中收集的652株肠杆菌科临床分离株的体外活性。使用头孢噻肟和头孢他啶筛选琼脂平板以及双ESBL E试验筛选菌株是否产生ESBL。采用E试验法测定替莫西林和五种对照药物的MIC。在一个中心实验室通过等电聚焦、针对SHV、TEM和CTX-M家族bla基因的PCR以及DNA测序对ESBL进行鉴定。产ESBL肠杆菌科细菌的患病率平均为11.8%，在不同医院之间为3.0%至29%。美罗培南总体上表现出最高的体外活性（MIC中位数为0.064μg；MIC90为0.19μg/ml），而头孢他啶（MIC90>256μg/ml）和环丙沙星（MIC90>32μg/ml）活性最差。替莫西林对超过90%的分离株有活性，包括大多数产AmpC酶和ESBL的分离株。这些数据表明多年来替莫西林对肠杆菌科细菌的活性保持良好，并显示出比利时重症监护病房中产ESBL肠杆菌科细菌分离株患病率的广泛差异。然而，需要进行前瞻性临床研究以验证替莫西林在治疗由产ESBL和/或AmpC酶的医院内肠杆菌科病原菌引起的微生物学确诊感染中的有效性。
