Korten Volkan, Söyletir Güner, Yalçın Ata Nevzat, Oğünç Dilara, Dokuzoğuz Başak, Esener Harika, Ulusoy Sercan, Tünger Alper, Aygen Bilgehan, Sümerkan Bülent, Arman Dilek, Dizbay Murat, Akova Murat, Hasçelik Gülşen, Eraksoy Haluk, Başaran Seniha, Köksal Iftihar, Bayramoğlu Gülçin, Akalın Halis, Sınırtaş Melda
Marmara University Faculty of Medicine, İstanbul, Turkey.
Mikrobiyol Bul. 2011 Apr;45(2):197-209.
The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest® strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC50 of doripenem against Pseudomonas spp. Was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC90 of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gramnegative pathogens, mostly Acinetobacter spp., MIC50 was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance.
本研究旨在测定多黏菌素、亚胺培南和美罗培南对临床革兰氏阴性菌分离株的体外活性。2008年9月至12月期间，从土耳其10个中心的重症监护病房（ICU）和非ICU患者中总共获得了596株临床分离株。分离株的来源为医院获得性肺炎患者（42.4%）、血流感染患者（40.4%）和复杂性腹腔内感染患者（17.1%）。其中，51.8%的分离株来自ICU患者。研究分离株包括49.8%的假单胞菌属、40.3%的肠杆菌科细菌和9.9%的其他革兰氏阴性菌。使用Etest®试纸条（AB Biodisk，瑞典索尔纳）对每个中心的所有分离株测定多黏菌素、亚胺培南和美罗培南的最低抑菌浓度（MIC）。在这些分离株中，188株（31.5%）对至少一种碳青霉烯类药物耐药。多黏菌素对假单胞菌属的MIC50为1mg/L，与美罗培南相似，比亚胺培南低两倍。在MIC水平为2mg/L时，多黏菌素对铜绿假单胞菌的敏感性为64%；在MIC水平为4mg/L时，亚胺培南和美罗培南的敏感性分别为53.9%和63%。多黏菌素和美罗培南的MIC90相似，均为0.12mg/L，而亚胺培南的活性则低四倍，为0.5mg/L。针对其他革兰氏阴性病原体，主要是不动杆菌属，多黏菌素的MIC50为8mg/L，其他两种碳青霉烯类药物为32mg/L。在MIC水平为8mg/L时，多黏菌素和美罗培南分别抑制了84.2%和72.1%的铜绿假单胞菌分离株。总体而言，多黏菌素对本研究中收集的病原体显示出与美罗培南相似或略好的活性，且比对亚胺培南的活性更好。在假单胞菌属中，多黏菌素是三种碳青霉烯类药物中活性最强的。多黏菌素和美罗培南对肠杆菌科细菌的活性相同，且比对亚胺培南的活性至少高四倍。得出的结论是，多黏菌素似乎是治疗医院获得性肺炎、血流感染和腹腔内感染的一种有前景的药物，特别是对于有发生抗菌药物耐药风险的患者。
