Department of Clinical Microbiology, The Conquest Hospital, East Sussex Healthcare Trust, Hastings, UK.
Int J Clin Pract. 2019 Sep;73(9):1-5. doi: 10.1111/ijcp.13387. Epub 2019 Jul 30.
Extended Spectrum βeta-lactamase (ESBL)-producing Enterobacteriaceae causing urinary tract infections (UTIs) appear resistant to many common oral agents. There is a growing need to discover new antibiotics to combat with emerging antibiotic resistance problem. Until the discovery of new antimicrobials, we can bring back forgotten antibiotics to our clinical formulary. Pivmecillinam (prodrug of mecillinam), an oral antimicrobial agent is effective against ESBL producing organisms. We analysed the sensitivity rates of ESBL-producing Enterobacteriaceae from urine samples to mecillinam and to document if pivmecillinam is a suitable alternative option in the treatment of UTI.
MATERIALS/METHODS: This retrospective study was conducted from September 2015 to September 2017. Data were collected from the pathology information system. Antimicrobial sensitivity testing on ESBL-producing Enterobacteriaceae isolates was carried out by disc diffusion method in accordance with The European Committee on Antimicrobial Susceptibility Testing.
A total of 986 ESBL-producing Enterobacteriaceae were tested for mecillinam during the study period. Of 986 organisms, Escherichia coli was the most common organism (889); followed by Klebsiella species (71) and others Enterobacteriaceae (26). Mecillinam sensitivity was found in 96% Escherichia coli (855/889 isolates), 83% Klebsiella species (59/71 isolates) and 88% other Enterobacteriaceae (23/26 isolates). Overall 95% (935/986 isolates) of ESBL-producing urinary isolates were sensitive to mecillinam.
Pivmecillinam appears to be suitable option to treat ESBL-producing Enterobacteriaceae causing uncomplicated UTI. Our results showed low resistance rate to mecillinam. We recommend the use of pivmecillinam in uncomplicated UTIs because of ESBL-producing Enterobacteriaceae. More studies on in vitro activity of mecillinam against ESBL producing organism and its use and clinical outcome should be tried in future.
产超广谱β-内酰胺酶（ESBL）的肠杆菌科导致尿路感染（UTI），对许多常见的口服药物表现出耐药性。人们越来越需要发现新的抗生素来对抗新出现的抗生素耐药问题。在发现新的抗菌药物之前，我们可以将被遗忘的抗生素重新纳入我们的临床处方。匹美西林（美西林的前体药物）是一种口服抗菌药物，对产 ESBL 的生物体有效。我们分析了尿液样本中产 ESBL 的肠杆菌科对美西林的敏感性率，并记录匹美西林是否是治疗 UTI 的一种合适的替代选择。
材料/方法：这项回顾性研究于 2015 年 9 月至 2017 年 9 月进行。数据从病理信息系统中收集。采用纸片扩散法按照欧洲抗菌药物敏感性试验委员会的标准对产 ESBL 的肠杆菌科分离株进行抗菌药物敏感性试验。
在研究期间，共对 986 株产 ESBL 的肠杆菌科进行了美西林药敏试验。在 986 株细菌中，大肠埃希菌最为常见（889 株）；其次是克雷伯菌属（71 株）和其他肠杆菌科（26 株）。美西林敏感性分别为 96%（855/889 株）、83%（59/71 株）和 88%（23/26 株）的大肠埃希菌、克雷伯菌属和其他肠杆菌科。总体而言，986 株产 ESBL 的尿路感染分离株中，95%（935/986 株）对美西林敏感。
匹美西林似乎是治疗产 ESBL 的肠杆菌科引起的单纯性尿路感染的合适选择。我们的结果显示对美西林的耐药率较低。我们建议在治疗产 ESBL 的肠杆菌科引起的单纯性尿路感染时使用匹美西林。未来应进一步研究美西林对产 ESBL 病原体的体外活性及其应用和临床疗效。
