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目的 :分析引起肾盂肾炎复发的细菌菌谱、药敏试验和产超广谱 β-内酰胺酶 (ESBLs)情况 ,并观察舒巴坦 /头孢哌酮的治疗效果。方法 :2 8例肾盂肾炎复发患者做尿细菌培养、药敏试验和检测ESBLs ,并用舒巴坦 /头孢哌酮治疗。结果 :革兰氏阴性杆菌感染占 6 4 % ,球菌感染占 36 %。革兰氏阴性杆菌产ESBLs共 14株 ,占阴性杆菌感染 78% ,其中复发 2次的阴性杆菌产酶率为 5 7% ,复发 3次以上的阴性杆菌产酶率为 91%。舒巴坦 /头孢哌酮与头孢哌酮、头孢三嗪、头孢他啶比效 ,药物敏感率和MIC90 均有显著性差异 (P <0 .0 5 )。舒巴坦 /头孢哌酮与头孢哌酮对产ESBLs阴性杆菌抗菌作用比较 ,两者高敏率分别为 92 .9%和 35 .7% (P <0 .0 1)。用舒巴坦 /头孢哌酮治疗后 ,尿细菌转阴率 92 .8%。结论 :杆菌是肾盂肾炎复发的重要致病菌 ,多数革兰氏阴性杆菌产ESBLs,产酶率与复发次数有关 ;头孢哌酮与舒巴坦配伍能增强对ESBLs的稳定性 ,是治疗肾盂肾炎复发有效的药物。
OBJECTIVE: To analyze the bacteria spectrum, susceptibility testing and production of ESBLs that cause recurrence of pyelonephritis and to observe the therapeutic effect of sulbactam / cefoperazone. METHODS: Twenty-eight patients with recurrent pyelonephritis were tested for urinary bacterial culture, susceptibility testing, and ESBLs testing with sulbactam / cefoperazone. Results: Gram-negative bacilli accounted for 64% and cocci infections accounted for 36%. Gram-negative bacilli produced ESBLs a total of 14 strains, accounting for 78% of negative bacilli infection, of which the recurrence of two negative bacilli enzyme yield was 57%, more than 3 times the recurrence of negative bacillus enzyme production rate of 91%. Sulbactam / cefoperazone and cefoperazone, cefotaxime, ceftazidime specific efficacy, drug sensitivity and MIC90 were significantly different (P <0.05). The antibacterial effect of sulbactam / cefoperazone and cefoperazone on ESBLs negative bacilli were 92.9% and 35.7% (P <0.01), respectively. After treatment with sulbactam / cefoperazone, the rate of urine bacterial negative conversion was 92.8%. Conclusion: Bacillus is an important pathogen of recurrence of pyelonephritis. Most Gram-negative bacilli produce ESBLs, and the rate of enzyme production is related to the number of relapse. The compatibility of cefoperazone and sulbactam can enhance the stability of ESBLs and is the treatment of pyelonephritis Recurring effective drugs.