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Comparative in vitro activity of piperacillin-tazobactam and temocillin against third-generation cephalosporin-resistant carbapenem-susceptible Escherichia coli and Klebsiella pneumoniae

機譯：哌拉西林-他唑巴坦和替莫西林對第三代頭孢菌素耐藥、碳青霉烯類敏感的大腸桿菌和肺炎克雷伯菌的體外活性比較

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Carbapenems are considered the drugs of choice for first-line treatment of severe infections caused by carbapenem-susceptible, extended-spectrum β-lactamases (ESBL)-producing Enterobacterales, while piperacillin-tazobactam has been recommended as an alternative for treatment of non-severe infections. Temocillin is stable to ESBL and AmpC enzymes and may thus represent another treatment option. This study assessed the in vitro activity of piperacillin-tazobactam and temocillin against third-generation cephalosporin (3GC)-resistant Escherichia coli and Klebsiella pneumoniae, as compared to 3GC-susceptible isolates of either species.One hundred and nine isolates from hospitalized patients with bloodstream and urinary tract infections were tested. All isolates were collected during the resistance surveillance study of the Paul-Ehrlich-Society for Chemotherapy in 2016/17. Minimum inhibitory concentrations (MICs) were determined by broth microdilution according to the standard ISO 20776-1 and interpreted using EUCAST clinical breakpoints (version 11.0).Seventy-nine isolates (E. coli, n=58; K. pneumoniae, n=21) were 3GC-resistant and 30 (E. coli, n=15; K. pneumoniae, n=15) were 3GC-susceptible. Susceptibility to piperacillin-tazobactam was detected in 93.3% of 3GC-susceptible isolates (for both E. coli and K. pneumoniae) and in 79.3% and 57.1% of the 3GC-resistant E. coli and K. pneumoniae, respectively. In contrast, 3GC-susceptible isolates were 100% susceptible to temocillin as were 94.8% and 90.5% of the 3GC-resistant E. coli and K. pneumoniae, respectively.In conclusion, temocillin demonstrated potent in vitro activity against carbapenem-susceptible, 3GC-resistant E. coli and K. pneumoniae from bloodstream and urinary tract infection samples, with susceptibility rates exceeding those of piperacillin-tazobactam.
機譯：碳青霉烯類被認為是一線治療由碳青霉烯類敏感、廣譜 β-內酰胺酶 （ESBL） 產生的腸桿菌引起的嚴重感染的首選藥物，而哌拉西林-他唑巴坦已被推薦作為治療非重度感染的替代藥物。替莫西林對 ESBL 和 AmpC 酶穩(wěn)定，因此可能代表另一種治療選擇。本研究評估了哌拉西林-他唑巴坦和替莫西林對第三代頭孢菌素 （3GC） 耐藥的大腸桿菌和肺炎克雷伯菌的體外活性，與任一物種的 3GC 敏感菌株相比。對 109 例來自血流和尿路感染住院患者的分離株進行了檢測。所有分離株均在 2016/17 年 Paul-Ehrlich-Society for Chemotherapy 的耐藥性監(jiān)測研究中收集。根據標準 ISO 20776-1 通過肉湯微量稀釋確定最低抑菌濃度 （MIC），并使用 EUCAST 臨床斷點（11.0 版）進行解釋。79 株 （大腸桿菌，n=58;肺炎克雷伯菌，n=21） 對 3GC 耐藥，30 株 （大腸埃希菌，n=15;肺炎克雷伯菌，n=15） 對 3GC 敏感。在 93.3% 的 3GC 敏感菌株（大腸埃希菌和肺炎克雷伯菌）和 79.3% 和 57.1% 的 3GC 耐藥大腸埃希菌和肺炎克雷伯菌中檢測到對哌拉西林-他唑巴坦的敏感性。相比之下，3GC 敏感菌株對替莫西林的敏感性為 100%，3GC 耐藥大腸桿菌和肺炎克雷伯菌的敏感性分別為 94.8% 和 90.5%。總之，替莫西林對血液和尿路感染樣本中碳青霉烯類敏感、3GC 耐藥的大腸桿菌和肺炎克雷伯菌表現出有效的體外活性，藥敏率超過哌拉西林-他唑巴坦。

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