Ferrara A, Dos Santos C, Cimbro M
Cattedra di Chemioterapia, Università di Pavia, Pavia, Italia.
Chemotherapy. 1998 Sep-Oct;44(5):313-7. doi: 10.1159/000007128.
Extended-spectrum beta-lactamase (ESBL) production among members of the family Enterobacteriaceae generally involves resistance to oxyimino-cephalosporins and monobactams, while implying different susceptibility profiles with other antimicrobial agents. We have investigated the activity of some beta-lactam antibiotics, alone or in double and triple combinations with beta-lactamase inhibitors, in the presence or absence of tobramycin (TOB), against some Enterobacteriaceae producing ESBL by means of time-kill curves. Antimicrobials employed were ceftazidime (CAZ), cefotaxime (CTX), TOB, ampicillin (AMP), ampicillin-sulbactam (ASL), amoxicillin (AML), amoxicillin-clavulanic acid (AMC), piperacillin (PIP) and piperacillin-tazobactam (TZP), at 1/4 minimum inhibitory concentration for susceptible strains and at achievable serum concentrations for resistant strains. Only the combinations CTX-ASL, CAZ-ASL and PIP-ASL were synergistic, both at 6 and 24 h, on some strains of Klebsiella species.
肠杆菌科细菌中产超广谱β-内酰胺酶（ESBL）通常意味着对氧亚氨基头孢菌素和单环β-内酰胺类耐药，同时对其他抗菌药物表现出不同的敏感性。我们通过时间杀菌曲线研究了一些β-内酰胺类抗生素单独使用，或与β-内酰胺酶抑制剂联合使用，在有或没有妥布霉素（TOB）存在的情况下，对一些产ESBL的肠杆菌科细菌的活性。使用的抗菌药物有头孢他啶（CAZ）、头孢噻肟（CTX）、TOB、氨苄西林（AMP）、氨苄西林-舒巴坦（ASL）、阿莫西林（AML）、阿莫西林-克拉维酸（AMC）、哌拉西林（PIP）和哌拉西林-他唑巴坦（TZP），对敏感菌株采用1/4最低抑菌浓度，对耐药菌株采用可达到的血清浓度。仅CTX-ASL、CAZ-ASL和PIP-ASL组合在6小时和24小时时，对某些克雷伯菌属菌株具有协同作用。
