Chachaty E, Bourneix C, Renard S, Bonnay M, Andremont A
Laboratoire d'Ecologie Microbienne, Institut Gustave-Roussy, Villejuif, France.
Antimicrob Agents Chemother. 1993 Jul;37(7):1432-5. doi: 10.1128/AAC.37.7.1432.
Microbial changes including the shedding of Clostridium difficile, fecal beta-lactamase activity, and gastrointestinal symptoms were assessed in 51 healthy volunteers given 200 mg of cefixime twice daily for 8 days. The number of organisms of the family Enterobacteriaceae (means +/- standard deviations) dropped from 6.9 +/- 1.1 to 3.9 +/- 1.8 log CFU/g of feces (P < 0.01), whereas counts of enterococci rose from 7.0 +/- 1.5 to 9.0 +/- 1.0 log CFU/g of feces (P < 0.01). Both counts returned to their initial levels 50 days after the cessation of treatment. Cefixime did not significantly modify the frequency of fecal excretion of Pseudomonas aeruginosa, Staphylococcus spp., yeasts, or members of the Enterobacteriaceae resistant to ceftazidime or ampicillin. The proportion of subjects shedding C. difficile rose from 6% before treatment to 57% (P < 0.01) at the end of treatment but returned to 8% 50 days thereafter. No case of pseudomembranous colitis was observed. Stool changes occurred in 13 volunteers during treatment (25%) and in 2 others more than 10 days after the end of treatment (4%). These changes were not significantly associated with the shedding of toxigenic strains of C. difficile or with the presence of toxin A in feces. By contrast, during treatment, stool changes occurred in 8 of the 18 volunteers (44%) who had antibiotic activity in their feces but in only 5 of the 33 (15%) for whom no such activity was found (P < 0.05). The absence of antibiotic activity in the feces was itself linked with the presence of beta-lactamase activity in the feces. Since we had found earlier that fecal beta-lactamase activity afforded protection against alteration in stool consistency during treatments with oral cephalosporins, the present study confirmed our previous preliminary results in this respect.
对51名健康志愿者进行了评估，这些志愿者每天两次服用200毫克头孢克肟，持续8天，期间观察了包括艰难梭菌排出、粪便β-内酰胺酶活性及胃肠道症状在内的微生物变化。肠杆菌科细菌数量（均值±标准差）从6.9±1.1降至3.9±1.8 log CFU/g粪便（P<0.01），而肠球菌数量从7.0±1.5升至9.0±1.0 log CFU/g粪便（P<0.01）。治疗停止50天后，这两种细菌数量均恢复至初始水平。头孢克肟对铜绿假单胞菌、葡萄球菌属、酵母菌或对头孢他啶或氨苄西林耐药的肠杆菌科细菌的粪便排泄频率无显著影响。排出艰难梭菌的受试者比例从治疗前的6%升至治疗结束时的57%（P<0.01），但50天后又降至8%。未观察到假膜性结肠炎病例。13名志愿者在治疗期间出现大便改变（25%），另外2名在治疗结束10天以上出现大便改变（4%）。这些改变与产毒艰难梭菌菌株的排出或粪便中毒素A的存在无显著关联。相比之下，治疗期间，粪便中有抗生素活性的18名志愿者中有8名（44%）出现大便改变，而粪便中无此类活性的33名志愿者中只有5名（15%）出现大便改变（P<0.05）。粪便中无抗生素活性本身与粪便中β-内酰胺酶活性的存在有关。由于我们 earlier发现粪便β-内酰胺酶活性可防止口服头孢菌素治疗期间大便稠度改变，本研究证实了我们此前在这方面的初步结果。 （注：原文中earlier翻译为“earlier”有误，应改为“earlier”，翻译为“更早地” ）
