β内酰胺类抗生素对产ESBL肺炎克雷伯菌小鼠肺炎疗效探究.docVIP

β内酰胺类抗生素对产ESBL肺炎克雷伯菌小鼠肺炎疗效探究 　 作者：裴迎华 张杰 马越 李景云 【摘要】 目的 评价几种β内酰胺类抗生素对不同的产超广谱β内酰胺酶(ESBL)肺炎克雷伯菌动物肺炎模型的疗效。方法 选择临床分离的2株对实验用抗生素敏感的产ESBL肺炎克雷伯菌建立小鼠肺炎模型。根据细菌分为GX6998和Tian 29两组，于感染后6h给药。对照组腹腔注射生理盐水0.5ml； 治疗 组分别给予头孢哌酮/舒巴坦、头孢他啶、头孢吡肟和哌拉西林/三唑巴坦。连续治疗72h后，根据细菌计数结果评价疗效。结果 体外药敏试验表明Tian 29对4种抗生素的MIC值均大于GX6998，但仍在敏感范围内。4种抗生素治疗后，各组病死率均显著减低。GX6998组中4种抗生素均可显著降低肺组织匀浆的细菌计数(Plt;0.01)。Tian 29组中头孢哌酮/舒巴坦、头孢他啶可以显著降低肺组织匀浆的细菌计数(Plt;0.05)；头孢吡肟和哌拉西林/三唑巴坦也可使组织匀浆的细菌计数减少，但与对照组比较差异无显著性(Pgt;0.05)。比较同一种抗生素对2株细菌的清除作用发现，4种抗生素对GX6998的清除作用均强于Tian 29(Plt;0.01)。结论 体外敏感的广谱β内酰胺类抗生素和β内酰胺酶抑制剂复合制剂治疗产ESBL肺炎克雷伯菌感染均可显著降低动物模型的死亡率，减少肺组织匀浆细菌计数。但如果细菌对抗生素的MIC升高，将会影响治疗效果。 论文代写 【关键词】 超广谱β内酰胺酶； β内酰胺类抗生素； 肺炎克雷伯菌； 药效学 ABSTRACT Objective To evaluate the efficacy of several βlactams against ESBL producing Klebsiella pneumoniae pneumonia in a mouse model of peneumonia. Methods Two clinical Klebsiella pneumoniae strains susceptible to the experimental antimicrobial agents, Klebsiella pneumoniae GX6998 and Tian 29, were divided into two groups for mouse pneumonia infection respectively. After sixhour infection, mice were intraperitoneally injected with 0.5ml 0.9% NaCl for control; mice were intraperitoneally injected with ceftazidime, cefepime, cefoprazone plus sulbactam and piperacillin plus tazobactam respectively for trial. Seventytwo hours later, therapy efficacies were evaluated with bacterial counts. Results All the trial groups had significantly lower mortality than control groups (Plt;0.05). Compared with the control groups, in GX6998infected groups, the bacterial amounts with all the testing agents were significantly decreased (Plt;0.01); in Tian 29infected group, the bacterial amounts with cefoprazone plus sulbactam and ceftazidime were significantly decreased (Plt;0.05); in cefepime and piperacillin plus tazobactam groups, bacterial amounts were reduced without significant difference with that of the control group (Pgt;0.05). Conclusion The combinations of broadspectrum βlactams and βlactamases