Vanhoof R, Carpentier M, Glupczynski Y, Gordts B, Magerman K, Nyssen H J, Simon A, Surmont I, Van de Vyvere M, Van Landuyt H, Van Nimmen L, Van Noyen R
Pasteurinstituut, Eenheid Antibiotica-onderzoek, Brussel.
Acta Clin Belg. 1996;51(6):377-85. doi: 10.1080/22953337.1996.11718535.
One hundred seventy six consecutive, non-duplicate pneumococcal isolates from clinical specimens collected from November 1994 through February 1995 in nine general hospitals throughout Belgium were tested for their in vitro susceptibilities to penicillin, ampicillin, amoxycillin with and without clavulanate, cefaclor, cefuroxime, cefonicid, cefprozil, cefpodoxime, cefotaxime, imipenem, tetracycline, and erythromycin by means of the NCCLS microdilution test. The overall rate of decreased susceptibility to penicillin was 12.5%, including 6.3% of intermediately and 6.3% of fully resistant isolates. Penicillin, ampicillin amoxycillin, amoxycillin/clavulanate, cefuroxime, cefotaxime and imipenem had the highest activity on a weight basis (MIC50 < or = 0.008 microgram/ml), followed by cefpodoxime and erythromycin (MIC50 of 0.015 microgram/ml), cefprozil and tetracycline (MIC50 of 0.12 microgram/ml), and eventually, cefaclor and cefonicid (MIC50 of 0.5 microgram/ml). Aggregate rates of susceptible plus intermediately resistant isolates at NCCLS-recommended breakpoints, i.e. overall percentages of isolates likely to respond to increased antibiotic doses in vivo (except for meningitis), were 100.0% for imipenem and cefotaxime, 98.9% for amoxycillin with and without clavulanate, 93.8% for penicillin, and 90.9% for cefuroxime. Overall rates of susceptibility to erythromycin and tetracycline amounted to 78.4% and 72.7%, respectively. MIC values of all beta-lactams increased with those of penicillin. Ampicillin was equally active as penicillin against isolates with reduced susceptibility to the latter (MIC90 of 2 micrograms/ml); imipenem, cefotaxime, and amoxycillin with and without clavulanate however, were more active (MIC90 3, 1, and 1 doubling dilution, respectively, below that of penicillin), while cefpodoxime, cefuroxime, cefprozil, cefonicid, and cefaclor on the other hand, were less active (MIC90, 1, 1, 2, 5, and 5 doubling dilutions, respectively, above that of penicillin). In conclusion, the present data confirm that pneumococcal resistance to penicillin has increased in Belgium, suggest that resistance to erythromycin may have stabilised, and reveal an unexpectedly high rate of resistance to tetracycline. Imipenem was the most active antibiotic tested overall, and amoxycillin with or without clavulanate the most active oral antibiotic, with activity almost similar to that of cefotaxime.
对1994年11月至1995年2月期间从比利时九家综合医院采集的临床标本中分离出的176株连续、非重复肺炎球菌菌株，采用美国国家临床实验室标准委员会（NCCLS）微量稀释法检测其对青霉素、氨苄西林、含和不含克拉维酸的阿莫西林、头孢克洛、头孢呋辛、头孢尼西、头孢丙烯、头孢泊肟、头孢噻肟、亚胺培南、四环素和红霉素的体外敏感性。对青霉素敏感性降低的总体发生率为12.5%，其中中介耐药菌株占6.3%，完全耐药菌株占6.3%。按重量计算，青霉素、氨苄西林、阿莫西林、阿莫西林/克拉维酸、头孢呋辛、头孢噻肟和亚胺培南活性最高（MIC50≤0.008微克/毫升），其次是头孢泊肟和红霉素（MIC50为0.015微克/毫升）、头孢丙烯和四环素（MIC50为0.12微克/毫升），最后是头孢克洛和头孢尼西（MIC50为0.5微克/毫升）。在NCCLS推荐的断点处，敏感加中介耐药菌株的总发生率，即体内可能对增加抗生素剂量有反应的菌株的总体百分比（脑膜炎除外），亚胺培南和头孢噻肟为100.0%，含和不含克拉维酸的阿莫西林为98.9%，青霉素为93.8%，头孢呋辛为90.9%。对红霉素和四环素的总体敏感率分别为78.4%和72.7%。所有β-内酰胺类药物的MIC值均随青霉素MIC值的升高而升高。氨苄西林对青霉素敏感性降低的菌株的活性与青霉素相当（MIC90为2微克/毫升）；然而，亚胺培南、头孢噻肟以及含和不含克拉维酸的阿莫西林活性更高（MIC90分别比青霉素低3、1和1个稀释倍数），而头孢泊肟、头孢呋辛、头孢丙烯、头孢尼西和头孢克洛则活性较低（MIC90分别比青霉素高1、1、2、5和5个稀释倍数）。总之，目前的数据证实比利时肺炎球菌对青霉素的耐药性有所增加，提示对红霉素的耐药性可能已趋于稳定，并显示出对四环素的耐药率出乎意料地高。亚胺培南是总体上活性最高的测试抗生素，含或不含克拉维酸的阿莫西林是活性最高的口服抗生素，其活性与头孢噻肟几乎相似。
