Kouda M, Kumagai I, Kobayashi J, Sugai R, Matsuzaki H
Department of Central Clinical Laboratories, Tokyo Metropolitan Police Hospital.
Jpn J Antibiot. 1990 Apr;43(4):636-58.
We evaluated relationships between production of beta-lactamase and their resistances to beta-lactams, effect of sulbactam (SBT), a beta-lactamase inhibitor, against beta-lactam resistant strains, and combined effect of sulbactam/cefoperazone (SBT/CPZ) with other antibiotics against multi-resistant strains. Through these studies, we obtained the following results. 1. Most of the strains resistant to beta-lactams were beta-lactamase producers. 2. Relationships between the production of beta-lactamase and their resistances to beta-lactams indicate that their resistances generally were the highest in producers of both penicillinase (PCase) and cephalosporinase (CEPase), moderate in producers of either PCase or CEPase, and the lowest in beta-lactamase non-producers. Most of highly-resistant strains of MRSA appeared to be beta-lactamase non-producers though some exceptions were observed among methicillin-resistant Staphylococcus aureus (MRSA), Serratia marcescens and Pseudomonas aeruginosa. 3. SBT showed good effect against PCase producers, moderate effect against producers of both PCase and CEPase, little effect against CEPase producers, and no effect against beta-lactamase non-producers. 4. Results of combined effect of SBT/CPZ with other antibiotics indicated that good synergism was obtained by combining SBT/CPZ with fosfomycin (FOM) or piperacillin against multi-resistant strains of Proteus spp., Enterobacter cloacae, and S. marcescens, by combining SBT/CPZ with ceftazidime (CAZ) or FOM in methicillin-sensitive S. aureus and by combining SBT/CPZ with CAZ in P. aeruginosa. 5. Better synergism was obtained with the higher concentrations of antibiotics.
我们评估了β-内酰胺酶的产生与细菌对β-内酰胺类抗生素耐药性之间的关系、β-内酰胺酶抑制剂舒巴坦(SBT)对β-内酰胺类耐药菌株的作用,以及舒巴坦/头孢哌酮(SBT/CPZ)与其他抗生素联合应用对多重耐药菌株的联合作用。通过这些研究,我们获得了以下结果。1. 大多数对β-内酰胺类抗生素耐药的菌株是β-内酰胺酶产生菌。2. β-内酰胺酶的产生与细菌对β-内酰胺类抗生素耐药性之间的关系表明,青霉素酶(PCase)和头孢菌素酶(CEPase)均产生菌的耐药性通常最高,仅产生PCase或CEPase的菌株耐药性中等,而β-内酰胺酶非产生菌的耐药性最低。尽管在耐甲氧西林金黄色葡萄球菌(MRSA)、粘质沙雷氏菌和铜绿假单胞菌中观察到一些例外情况,但大多数高度耐药的MRSA菌株似乎是β-内酰胺酶非产生菌。3. SBT对PCase产生菌显示出良好的效果,对PCase和CEPase均产生菌有中等效果,对CEPase产生菌几乎没有效果,对β-内酰胺酶非产生菌则无作用。4. SBT/CPZ与其他抗生素联合应用的结果表明,SBT/CPZ与磷霉素(FOM)或哌拉西林联合应用对变形杆菌属、阴沟肠杆菌和粘质沙雷氏菌的多重耐药菌株有良好的协同作用,SBT/CPZ与头孢他啶(CAZ)或FOM联合应用对甲氧西林敏感的金黄色葡萄球菌有协同作用,SBT/CPZ与CAZ联合应用对铜绿假单胞菌有协同作用。5. 抗生素浓度越高,协同作用越好。
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