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目的评价头孢他啶及头孢吡肟对产超广谱β内酰胺酶(ESBL)肺炎克雷伯菌大鼠肺炎的治疗效果。方法选取产ESBL肺炎克雷伯菌3种菌株,建立3组大鼠肺炎模型(kpn1、kpn2、kpn3组)。3种菌体外试验对头孢噻肟耐药,对哌拉西林/他唑巴坦敏感,对头孢他啶、头孢吡肟为:1组均敏感;2组头孢他啶敏感,头孢吡肟耐药;3组头孢吡肟敏感,头孢他啶耐药。每组分5个治疗亚组(头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、头孢噻肟、生理盐水对照亚组),治疗96h后进行评价。结果kpn1组:哌拉西林/他唑巴坦、头孢他啶、头孢吡肟亚组生存率(75.0%、76.9%、80.0%)明显高于头孢噻肟、生理盐水对照亚组(36.0%、32.0%),前3组肺组织匀浆活菌计数[(10.8±2.8)、(11.1±3.2)、(11.0±3.7)lgCFU/g]明显低于头孢噻肟、生理盐水对照亚组[(15.7±5.6)、(16.0±5.5)lgCFU/g]。kpn2组:哌拉西林/他唑巴坦、头孢他啶亚组生存率(79.2%、73.1%)明显高于头孢噻肟、生理盐水对照亚组(42.3%、33.3%),前2组肺组织匀浆活菌计数[(10.7±2.3)、(11.0±2.7)lgCFU/g]明显低于头孢噻肟、生理盐水对照亚组[(15.5±5.4)、(15.8±4.6)lgCFU/g]。kpn3组:哌拉西林/他唑巴坦、头孢吡肟亚组生存率(80.8%、75.0%)明显高于头孢噻肟、生理盐水对照亚组(37.5%、34.6%)。结论体外敏感的头孢他啶、头孢吡肟治疗产ESBL肺炎克雷伯菌大鼠肺炎,可提高生存率,降低肺组织lgCFU/g,与哌拉西林/他唑巴坦作用相当。
Objective To evaluate the therapeutic effect of ceftazidime and cefepime in the treatment of pneumonia in Klebsiella pneumoniae producing extended-spectrum β-lactamases (ESBL). Methods Three strains of ESBL-producing Klebsiella pneumoniae were selected to establish three groups of rat pneumonia model (kpn1, kpn2, kpn3 group). Three kinds of bacteria in vitro tests were resistant to cefotaxime, sensitive to piperacillin / tazobactam, ceftazidime, cefepime: 1 group were sensitive; 2 ceftazidime sensitive, cefepime resistant; 3 groups Cefepime sensitive, ceftazidime resistant. Five treatment subgroups (ceftazidime, cefepime, piperacillin / tazobactam, cefotaxime, saline control subgroup) were given in each group and were evaluated after 96 hours treatment. Results In the kpn1 group, the survival rates of piperacillin / tazobactam, ceftazidime and cefepime subgroup were significantly higher than those of cefotaxime and saline control subgroups (36.0%, 32.0% vs 75.0%, 76.9%, 80.0% ), The viable count of lung homogenates of the first three groups was significantly lower than that of the cefotaxime group ([(10.8 ± 2.8), (11.1 ± 3.2), (11.0 ± 3.7) lgCFU / g] 5.6), (16.0 ± 5.5) lgCFU / g]. In the kpn2 group, the survival rates of piperacillin / tazobactam and ceftazidime subgroups (79.2%, 73.1%) were significantly higher than those of cefotaxime and saline control subgroups (42.3% and 33.3%), respectively The count of viable cells in [(10.7 ± 2.3), (11.0 ± 2.7) lgCFU / g] was significantly lower than that in cefotaxime, saline control group [(15.5 ± 5.4), (15.8 ± 4.6) lgCFU / g] In the kpn3 group, the survival rates of piperacillin / tazobactam and cefepime subgroup were significantly higher than those of cefotaxime and saline control subgroups (37.5% and 34.6%, 80.8% and 75.0%, respectively). CONCLUSION: Ceftazidime and cefepime in vitro treatment of pneumonia in ESBL-producing Klebsiella pneumoniae rats can increase the survival rate, reduce lgCFU / g in lung tissue, which is equivalent to piperacillin / tazobactam.