包括头孢洛扎/他唑巴坦在内的肠外抗菌药物对医院获得性呼吸道病原体的抗菌效力：经验性和针对性治疗的考量
Potency of parenteral antimicrobials including ceftolozane/tazobactam against nosocomial respiratory tract pathogens: considerations for empiric and directed therapy.
作者信息
Sutherland Christina A, Nicolau David P
机构信息
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA.
Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA; Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA.
出版信息
J Thorac Dis. 2017 Jan;9(1):214-221. doi: 10.21037/jtd.2017.01.26.
BACKGROUND
Empiric therapy decisions are predicated on knowledge of both the epidemiology and antimicrobial susceptibility of the probable infecting pathogen(s). The objective of this study was to evaluate the microbial distribution and phenotypic profiles of nosocomial respiratory isolates collected from multiple US hospitals and assess the clinical utility of various monotherapy and combination regimens.
METHODS
Hospitals provided consecutive non-duplicate adult inpatients Gram-negative nosocomial respiratory isolates from cultures received ≥48 h after hospital admission. Minimum inhibitory concentrations (MICs) for 12 antimicrobials were determined using broth microdilution methods. An antibiogram was constructed for monotherapy regimens as well as combinations inclusive of either tobramycin (TOB) or ciprofloxacin (CIP).
RESULTS
Six hospitals provided 518 nosocomial respiratory isolates. (PSA) comprised 28% of the population followed by (13%), . (13%), (9%), (6%), (6%), and others (18%). When considering monotherapy for the Enterobacteriaceae & PSA ceftolozane/tazobactam (C/T) provided the highest (87%) percent susceptibility (%S) followed by meropenem (MEM), CIP, cefepime (FEP), ceftazidime (CAZ) and piperacillin-tazobactam (TZP) at 71-85%S. The addition of TOB > CIP improved the probability that the antimicrobial combination would provide ≥1 active agent.
CONCLUSIONS
PSA was the predominant nosocomial respiratory pathogen; however, the Enterobacteriaceae comprised an additional 53% in this survey. When considering empiric β-lactam monotherapy therapy for the entire spectrum of pathogens C/T provided the highest (78%) %S followed by MEM, FEP and TZP. The addition of either TOB > CIP to these β-lactams enhances the likelihood that an active agent would be selected when considering empirical therapy choices for nosocomial respiratory tract infections.
背景
经验性治疗决策基于对可能感染病原体的流行病学和抗菌药物敏感性的了解。本研究的目的是评估从美国多家医院收集的医院获得性呼吸道分离株的微生物分布和表型特征，并评估各种单药治疗和联合治疗方案的临床实用性。
方法
医院提供入院≥48小时后培养的连续非重复成年住院患者革兰氏阴性医院获得性呼吸道分离株。使用肉汤微量稀释法测定12种抗菌药物的最低抑菌浓度（MIC）。构建了单药治疗方案以及包含妥布霉素（TOB）或环丙沙星（CIP）的联合治疗方案的抗菌谱。
结果
六家医院提供了518株医院获得性呼吸道分离株。肺炎克雷伯菌（PSA）占菌株总数的28%，其次是鲍曼不动杆菌（13%）、铜绿假单胞菌（13%）、大肠埃希菌（9%）、阴沟肠杆菌（6%）、产气肠杆菌（6%）和其他菌属（18%）。对于肠杆菌科细菌和肺炎克雷伯菌，考虑单药治疗时，头孢洛扎/他唑巴坦（C/T）的敏感性最高（87%），其次是美罗培南（MEM）、环丙沙星（CIP）、头孢吡肟（FEP）、头孢他啶（CAZ）和哌拉西林/他唑巴坦（TZP），敏感性为71 - 85%。添加妥布霉素（TOB）比添加环丙沙星（CIP）更能提高抗菌药物联合治疗方案中至少有1种活性药物的概率。
结论
肺炎克雷伯菌是主要的医院获得性呼吸道病原体；然而，在本次调查中，肠杆菌科细菌占比达53%。对于所有病原体，考虑经验性β-内酰胺单药治疗时，头孢洛扎/他唑巴坦（C/T）的敏感性最高（78%），其次是美罗培南（MEM）、头孢吡肟（FEP）和哌拉西林/他唑巴坦（TZP）。在这些β-内酰胺类药物中添加妥布霉素（TOB）或环丙沙星（CIP），可提高在考虑医院获得性呼吸道感染经验性治疗选择时选择活性药物的可能性。
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