Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan.
Department of Pediatrics and Neonatology, Faculty of Medicine, Hashemite University, Zarqa, Jordan.
Microb Drug Resist. 2019 Oct;25(8):1132-1141. doi: 10.1089/mdr.2019.0065. Epub 2019 May 20.
Extended-spectrum beta-lactamase-producing (ESBL-EC) is increasing worldwide. The drugs of choice for treatment of ESBLs are parenteral carbapenems. The aim of this study was to evaluate the and efficacy of a new combination of oral cephalosporins and amoxicillin/clavulanate in treatment of ESBL-EC. A total of 150 ESBL-EC samples were collected over 1 year from two referral centers. Synergistic studies of cephalosporins and amoxicillin/clavulanate were performed using disk approximation and disk replacement methods. Combination treatment was assessed on 20 ESBL-EC urinary tract infection (UTI) patients. ESBL-EC isolates were confirmed in 150 patients with a mean age of 46.67 years, 75.2% of them being women. Antibiotic susceptibility testing of isolates indicated high resistance rate to oral antibiotics. The frequency of positive synergy and mean distance of synergy between cephalosporins and amoxicillin/clavulanate was significantly higher with cefotaxime and cefixime compared with cefpodoxime, cefdinir, and ceftazidime using disk approximation and disk replacement methods ( < 0.05). Addition of amoxicillin/clavulanate enhanced the susceptibility rate with cefixime from 8.6% to 86.3%, significantly higher than with other cephalosporins ( < 0.0005). Cefixime and amoxicillin/clavulanate synergy was not affected by age, gender, hospital, department, sample type, or bacterial load. Eighteen of 20 ESBL-EC-positive UTI patients had a positive synergy test and complete clinical and microbiological resolution after completion of cefixime and amoxicillin/clavulanate oral treatment course. Cefixime and amoxicillin/clavulanate combination therapy could be an effective oral outpatient treatment option for ESBL-EC. synergistic testing is simple and predictive of successful treatment.
产超广谱β-内酰胺酶（ESBL-EC）在全球范围内不断增加。治疗 ESBL 的首选药物是注射用碳青霉烯类药物。本研究旨在评估新型口服头孢菌素和阿莫西林/克拉维酸组合在治疗 ESBL-EC 中的疗效和安全性。
在一年的时间里，我们从两个转诊中心共收集了 150 株 ESBL-EC 样本。采用纸片逼近法和纸片替换法进行头孢菌素和阿莫西林/克拉维酸的协同研究。对 20 例 ESBL-EC 尿路感染（UTI）患者进行了联合治疗评估。
在 150 例 ESBL-EC 分离株患者中，确认了 ESBL-EC 分离株，平均年龄为 46.67 岁，其中 75.2%为女性。分离株的抗生素药敏试验表明，对口服抗生素的耐药率很高。与头孢泊肟、头孢地尼和头孢他啶相比，头孢噻肟和头孢克肟的协同阳性率和协同平均距离明显更高，纸片逼近法和纸片替换法（<0.05）。与其他头孢菌素相比，添加阿莫西林/克拉维酸可使头孢克肟的敏感性从 8.6%提高到 86.3%（<0.0005）。头孢克肟和阿莫西林/克拉维酸的协同作用不受年龄、性别、医院、科室、样本类型或细菌载量的影响。在完成头孢克肟和阿莫西林/克拉维酸口服治疗后，20 例 ESBL-EC 阳性 UTI 患者中有 18 例协同试验阳性，临床和微生物学完全缓解。头孢克肟和阿莫西林/克拉维酸联合治疗可能是治疗 ESBL-EC 的有效口服门诊治疗选择。协同试验简单且可预测治疗成功。
