头孢吡肟对质粒介导产AmpC β内酰胺酶大肠埃希菌接种效应研.docVIP

头孢吡肟对质粒介导产AmpC β内酰胺酶大肠埃希菌接种效应研 　 【摘要】 目的 本实验研究了临床分离的质粒介导AmpC β内酰胺酶大肠埃希菌，在两种接种浓度下(标准浓度105CFU/ml和高浓度107CFU/ml)测定头孢吡肟、头孢噻肟、头孢他啶、头孢哌酮/舒巴坦和亚胺培南的MIC值。方法 19株血培养的质粒介导的AmpC β内酰胺酶大肠埃希菌，其中10株单产ACT型，5株单产DHA型，4株产ACT+DHA型。采用琼脂稀释法测定头孢吡肟等5种抗生素在两种接种浓度下的MIC值。高接种浓度下测得的MIC值较标准接种浓度下的MIC值≥8倍时定义为有接种效应。结果 在标准接种浓度下，亚胺培南的敏感率为100%，头孢吡肟也有84.2%的高敏感率，头孢哌酮/舒巴坦的敏感率为5.3%，头孢噻肟和头孢他啶的敏感率为0。在两种接种浓度下，头孢吡肟MIC值增加从32倍到100多倍不等，100%有接种效应，而亚胺培南几乎没有接种效应。结论 头孢吡肟有明显的接种效应，尽管本文结果为实验室的体外实验结果，但仍建议：头孢吡肟不推荐为临床上 治疗 由质粒介导AmpC β内酰胺酶大肠埃希菌引起的严重感染的药物。 毕业论文 【关键词】 质粒介导的AmpC β内酰胺酶； 接种效应； 头孢吡肟 毕业论文 ABSTRACT Objectives To investigate the activity of cefepime, cefotaxime, ceftazidime, cefoperzone/sulbactam and imipenem in standard (105 CFU/ml) and high (107 CFU/ml) inoculum MIC tests against clinical isolates. Methods A total of 19 Escherichia coli blood isolates producing plasmidmediated AmpCtype βlactamase were selected including 10 isolates of ACT, 5 isolates of DHA and 4 isolates of ACT and DHA. Antimicrobial susceptibilities were determined using broth microdilution MIC tests with standard and 100fold higher inocula. The inoculum effect was defined as an Eightfold or greater MIC increase on testing with the higher inoculum compared with the stardard. Results Under the standard inoculum, antimicrobial susceptibility rates of imipenem, cefepime and sulperazon were 100%, 84% and 5.3% respectively, both cefotaxime and ceftazidime were 0. In tests with AmpC βlactamaseproducing E.coli isolates, the inoculum effect was most consistently detected with cefepime, cefotaxime, ceftazidime, sulperazon. However, the inoculum effect was least frequently detected with imipenem. Conclusion Although the inoculum effect is an in vitro laboratory phenomenon, these results suggest that cefepime may be an unreliable agent for therapy in cases of high inoculum infections caused by AmpC βlactamaseproducing Escherichia coli. 论文代写 KEY WORDS Plasmidmediated AmpCtype βlactamase; Inoculum effect,; Cefepime 革兰阴性菌大多都具有容纳