造血器疾患合併敗血症からの分離株に対するｍｅｒｏｐｅｎｅｍ，ｉｍｉｐｅｎｅｍ，ａｍｉｋａｃｉｎおよびｓｕｌｂａｃｔａｍ／ａｍｐｉｃｉｌｌｉｎの抗菌力の検討

DOI 被引用文献2件 参考文献21件

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  • Experimental studies on chemotherapy with meropenem, imipenem, amikacin and sulbactam/ampicillin for sepsis in patients with hematologic diseases.

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To investigate in vitro antimicrobial activities and bactericidal activities of meropenem (MEPM), imipenem (IPM), amikacin (AMK) and sulbactam/ampicillin (SBT/ABPC) against 19 clinical strains isolated from the blood of septic patients with hematologic diseases, MICs at 24h and MBCs at 6h (6h-MBCs) or 24h (24h-MBCs) after the addition of antibiotics were determined. All strains tested showed relatively high susceptibility (MIC≤1.56μg/mL) to some of the antimicrobials tested. Against Escherichia coli and Klebsiella pneumoniae, MEPM (MIC≤0.05μg/mL), IPM (MIC≤0.39μg/mL) and AMK (MIC≤6.25μg/mL) showed high antimicrobial activities, but the antimicrobial activities of SBT/ABPC (12.5≤MIC≤50μg/mL) were low. Although two carbapanem-resistant strains (MIC=12.5μg/mL) and an AMK-resistant strain (MIC=12.5μg/mL) were observed, other three strains of Pseudomonas aeruginosa tested showed relatively high susceptibilities to these antibiotics. Against Staphylococcus epidermidis, the other coagulase-negative staphylococci (CNS) and streptococci, MEPM (MIC≤1.56μg/mL), IPM (MIC≤0.39μg/mL) and SBT/ABPC (MIC≤3.13μg/mL) showed high antimicrobial activities. Since most of the 24h-MBCs of antibiotics tested were equivalent to each MIC, it was suggested that exposure to the antibiotics at MIC for 24h showed sufficiently high bactericidal activities. On the other hand, some of the 6h-MBCs were much higher than each MIC. This result suggested that the antibiotics tested required higher concentrations than the MIC to show sufficient bactericidal activity against some isolates, in practical use. The combined effects of carbapenems and AMK or SBT/ABPC against 30 clinical strains isolated from septic patients were examined by checkerboard titration assay. Against E. coli and K. pneumoniae, the combination of MEPM and SBT/ABPC (addition: 7 strains, indifference: 1 strain in 8 strains tested), against S. epidermidis and the other CNS, the combination of MEPM and AMK (synergism: 5 strains, addition: 4 strains in 9 strains tested), Enterococcus faecalis and streptococci, the combination of carbapenem (MEPM or IPM) and SBT/ABPC (synergism: 1 strain, addition: 4 strains in 5 strains tested) showed the highest combined effect in this study. Interestingly, against P. aeruginosa, MEPM (synergism: 7 strains, addition: 1 strain in 8 strains tested) showed a greater combined effect than IPM (addition: 5 strains, indifference: 3 strains in 8 strains tested) in combination with AMK. As far as these results are analyzed, it is suggested that for sepsis caused by E. coli or K. pneumoniae, monotherapy with carbapenems, especially meropenem, or combination therapy with carbapenems and AMK or SBT/ABPC is effective. For pseudomonal infection, combination therapy with MEPM and AMK is effective. The findings also suggest that monotherapy with carbapenems or SBT/ABPC, or combination therapy with carbapenems and AMK or SBT/ABPC is suitable for bacterial infection caused by CNS or streptococci.

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