Cahen P, Le Bourgeois M, Delacourt C, Coustère C, Nicaise P, de Blic J, Véron M, Scheinmann P, Gaillard J L
Department of Microbiology, Hôpital Necker-Enfants Malades, Paris, France.
Pediatrics. 1993 Feb;91(2):451-5.
The serum bactericidal test has been used for many years for optimal assessment of the efficacy of antibiotic therapy in patients with infective endocarditis and other bacterial infections. Its capacity to predict the bacteriological outcome of acute pulmonary exacerbations in patients with cystic fibrosis was evaluated. A total of 54 courses of intravenous antibiotic therapy were analyzed in 22 patients, whose ages ranged from 4 months to 24 years (mean age: 10 years). The serum bactericidal activity of blood samples, taken at expected peak and trough antibiotic levels on day 4 of therapy, were determined against the potentially pathogenic strains isolated in sputum at the time of admission. For 104 isolates (64 Pseudomonas aeruginosa, 28 Staphylococcus aureus, and 12 Haemophilus influenzae strains), the peak and trough bactericidal titers were compared to bacteriological outcome. Bacteriological success was defined as a decrease of 2 log10 units or more in the bacterial density in sputum between days 0 and 7 of therapy. At peak antibiotic levels, serum bactericidal titers of 1:128 or more were 96% (all isolates) and 89% (P aeruginosa isolates), predictive of cure, whereas serum bactericidal titers of less than 1:16 were 100% predictive of failure for all infecting bacteria. In patients aged less than 18 years, the best peak titer for predicting success was 1:64, with a predictive value of 96% for titers of 1:64 or greater. The peak titer that best predicted success in patients aged 18 years or more was 1:128, with a predictive value of only 83% for titers of 1:128 or greater.(ABSTRACT TRUNCATED AT 250 WORDS)
血清杀菌试验多年来一直用于最佳评估感染性心内膜炎和其他细菌感染患者抗生素治疗的疗效。本研究评估了其预测囊性纤维化患者急性肺部加重细菌学转归的能力。共分析了22例年龄从4个月至24岁（平均年龄：10岁）患者的54个静脉抗生素治疗疗程。在治疗第4天，采集预期抗生素血药浓度峰值和谷值时的血样，测定其针对入院时痰液中分离出的潜在致病菌株的血清杀菌活性。针对104株分离菌（64株铜绿假单胞菌、28株金黄色葡萄球菌和12株流感嗜血杆菌），比较其峰值和谷值杀菌滴度与细菌学转归情况。细菌学成功定义为治疗第0天至第7天痰液中细菌密度降低2个对数单位或更多。在抗生素血药浓度峰值时，血清杀菌滴度≥1:128对所有分离菌的治愈率预测率为96%，对铜绿假单胞菌分离菌的治愈率预测率为89%，而血清杀菌滴度＜1:16对所有感染细菌的治疗失败预测率为100%。在年龄＜18岁的患者中，预测成功的最佳峰值滴度为1:64，滴度≥1:64时预测值为96%。在年龄≥18岁的患者中，预测成功的最佳峰值滴度为1:128，滴度≥1:128时预测值仅为83%。（摘要截短于250字）
