Chaudhuri B N, Rodrigues C, Balaji V, Iyer R, Sekar U, Wattal Chand, Chitnis D S, Dhole T N, Joshi Sangeeta
AMRI Hospitals, Salt Lake, Kolkata.
J Assoc Physicians India. 2011 May;59:287-92.
This study was conducted in 9 centers spread over India from January 1 to December 31, 2007 to monitor in vitro susceptibility of Gram-negative bacilli to Group I carbapenem, ertapenem and other antimicrobials in intra-abdominal infections and to identify early changes in susceptibility pattern of community or hospital acquired organisms, with a focus on ESBL producers.
Gram-negative bacilli isolated from intra-abdominal samples of patients with documented intra-abdominal infections were processed for identification by conventional/ automated methods and antimicrobial susceptibility by Micro-Scan (Siemens) MIC panel against 12 antimicrobials (3rd and 4th generation cephalosporins, Groups I and II carbapenems, amikacin, levofloxacin, amoxicillin-clavulanic acid and piperacillin-tazobactam).
A total of 588 isolates were identified, of which 351 (60%) were E. coli and 114 (19%) were Klebsiella spp. 79% of E. coli and 70% of Klebsiella spp. were ESBL producers in general. 110 of E. coli and 35 of Klebsiella isolates were from community-acquired intra-abdominal infections. 80% of E. coli and 63% of Klebsiella isolates from community-acquired infections were ESBL producers, against 79% of E. coli and 73% of Klebsiella isolates from hospital-acquired infections. Amongst the ESBL-positive isolates of E. coli, 94% were susceptible in vitro to ertapenem, 96% to imipenem and 76% to piperacillin-tazobactam. For ESBL-positive isolates of Klebsiella spp., the corresponding figures were 80%, 94% and 59% respectively.
The study showed a high incidence of ESBL-producers amongst Enterobacteriaceae isolates from intra-abdominal infections in both community-acquired and hospital-acquired settings across India. Ertapenem was comparable with imipenem against ESBL-positive E. coli isolates, while imipenem was more effective than ertapenem against ESBL-positive Klebsiella isolates.
本研究于2007年1月1日至12月31日在印度各地的9个中心开展，以监测革兰氏阴性杆菌在腹腔感染中对I类碳青霉烯类药物厄他培南及其他抗菌药物的体外敏感性，并确定社区或医院获得性微生物敏感性模式的早期变化，重点关注产超广谱β-内酰胺酶（ESBL）的菌株。
从有记录的腹腔感染患者的腹腔样本中分离出革兰氏阴性杆菌，采用传统/自动化方法进行鉴定，并使用Micro-Scan（西门子）MIC板检测其对12种抗菌药物（第三代和第四代头孢菌素、I类和II类碳青霉烯类药物、阿米卡星、左氧氟沙星、阿莫西林-克拉维酸和哌拉西林-他唑巴坦） 的抗菌敏感性。
共鉴定出588株菌株，其中351株（60%）为大肠杆菌，114株（19%）为克雷伯菌属。总体而言，79%的大肠杆菌和70%的克雷伯菌属为产ESBL菌株。110株大肠杆菌和35株克雷伯菌分离株来自社区获得性腹腔感染。社区获得性感染的大肠杆菌分离株中80%为产ESBL菌株，克雷伯菌分离株中63%为产ESBL菌株，而医院获得性感染的大肠杆菌分离株中79%为产ESBL菌株，克雷伯菌分离株中73%为产ESBL菌株。在大肠杆菌的ESBL阳性分离株中，94%在体外对厄他培南敏感，96%对亚胺培南敏感，76%对哌拉西林-他唑巴坦敏感。对于克雷伯菌属的ESBL阳性分离株，相应数字分别为80%、94%和59%。
该研究表明，在印度社区获得性和医院获得性腹腔感染的肠杆菌科分离株中，产ESBL菌株的发生率很高。厄他培南对ESBL阳性大肠杆菌分离株的效果与亚胺培南相当，而亚胺培南对ESBL阳性克雷伯菌分离株的效果比厄他培南更好。
