Delmée M, Carpentier M, Glupczynski Y, Gordts B, Magerman K, Simon A, Surmont I, Van de Vyvere M, Van Landuyt H, Van Nimmen L, Van Noyen R
UCL, Unité de Microbiologie, Bruxelles.
Acta Clin Belg. 1996;51(4):237-43. doi: 10.1080/22953337.1996.11718516.
One hundred eighty consecutive, unduplicate isolates of Haemophilus influenzae from clinical specimens collected from November 1994 through February 1995 in nine general hospitals throughout Belgium were examined for beta-lactamase production using a nitrocefin-based test, and for their in vitro susceptibilities to ampicillin, amoxycillin/clavulanate, cefaclor, cefuroxime, cefotaxime, clarithromycin and azithromycin by means of the NCCLS agar dilution test. The isolates were all from respiratory tract specimens. The prevalence of capsular type b was 1.1%, and the overall rate of beta-lactamase production 16.7%. Rates of beta-lactamase production were higher in isolates from children (22.0%) than in those from adults (15.3%), and in isolates from upper respiratory tract specimens (22.0%) than in those from the lower respiratory tract (15.1%). Beta-lactamase-negative ampicillin resistance amounted to 1.1%. Cefotaxime had the highest activity on a weight basis [MIC (minimal inhibitory concentration) for 50% of the isolates tested (MIC50) < or = 0.06 microgram/ml], followed by ampicillin (MIC50 of 0.25 microgram/ml), amoxycillin/clavulanate and cefuroxime (MIC50 of 0.5 microgram/ml), azithromycin (MIC50 of 2 micrograms/ml), cefaclor (MIC50 of 4 micrograms/ml), and clarithromycin (MIC50 of 8 micrograms/ml). Cefotaxime was also the most active drug in terms of susceptibility rates of the isolates (100.0%), followed by amoxycillin/clavulanate and azithromycin (98.9%), cefuroxime (97.2%), cefaclor (89.4%), clarithromycin (82.8%), and ampicillin (82.2%). In conclusion, amoxycillin/clavulanate and cefuroxime retain an excellent activity against H. influenzae, while cefaclor lost some of its activity. The rate of susceptibility to azithromycin was markedly higher than that to clarithromycin; however, its ability to accumulate intracellularly while concentrations in serum and interstitial fluid remain low, should be considered, as it may represent a major drawback to its use in H. influenzae infections.
1994年11月至1995年2月期间，从比利时九家综合医院收集的临床标本中连续分离出180株未重复的流感嗜血杆菌，使用基于硝基头孢菌素的试验检测其β-内酰胺酶的产生情况，并通过美国国家临床实验室标准委员会（NCCLS）琼脂稀释试验检测它们对氨苄西林、阿莫西林/克拉维酸、头孢克洛、头孢呋辛、头孢噻肟、克拉霉素和阿奇霉素的体外敏感性。这些分离株均来自呼吸道标本。b型荚膜菌株的流行率为1.1%，β-内酰胺酶的总体产生率为16.7%。儿童分离株（22.0%）的β-内酰胺酶产生率高于成人分离株（15.3%），上呼吸道标本分离株（22.0%）的β-内酰胺酶产生率高于下呼吸道标本分离株（15.1%）。β-内酰胺酶阴性的氨苄西林耐药率为1.1%。按重量计算，头孢噻肟活性最高[50%受试分离株的最低抑菌浓度（MIC）（MIC50）≤0.06微克/毫升]，其次是氨苄西林（MIC50为0.25微克/毫升）、阿莫西林/克拉维酸和头孢呋辛（MIC50为0.5微克/毫升）、阿奇霉素（MIC50为2微克/毫升）、头孢克洛（MIC50为4微克/毫升）和克拉霉素（MIC50为8微克/毫升）。就分离株的敏感率而言，头孢噻肟也是最有效的药物（100.0%），其次是阿莫西林/克拉维酸和阿奇霉素（98.9%）、头孢呋辛（97.2%）、头孢克洛（89.4%）、克拉霉素（82.8%）和氨苄西林（82.2%）。总之，阿莫西林/克拉维酸和头孢呋辛对流感嗜血杆菌仍具有优异的活性，而头孢克洛的活性有所下降。阿奇霉素的敏感率明显高于克拉霉素；然而，应考虑到它在血清和组织间液浓度较低时在细胞内蓄积的能力，因为这可能是其用于流感嗜血杆菌感染的一个主要缺点。
