Ke paipai nei ka Infectious Diseases Society of America i kēia manawa i ka amoxicillin a me ka ampicillin, aminopenicillin (AP) antibiotic, i mau lāʻau i koho ʻia no ka mālama ʻana.enterococcusUTIs.2 Ua hoʻonui ʻia ka laha ʻana o ka enterococcus kū'ē i ka ampicillin.

ʻO ka mea nui, ʻo ka loaʻa ʻana o ka vancomycin-resistantenterococci(VRE) ua aneane papalua i keia mau makahiki i hala iho nei, me 30% o na ma'i enterococcal isolates i hoike ia mai he ku e i ka vancomycin.EnterococcusʻO nā ʻano ʻano me ka liʻiliʻi liʻiliʻi o ka hoʻopaʻa ʻana (MIC) ≥ 16 μg/mL i manaʻo ʻia ʻaʻole kūʻē i ka ampicillin.

Hoʻohana nā laboratories Microbiology i kēia wahi haʻihaʻi me ka nānā ʻole i ke kahua o ka maʻi. Kākoʻo ka ʻikepili Pharmacokinetic, pharmacodynamics, a me ka hoʻāʻo ʻana i ka hoʻohana ʻana i nā lāʻau antibiotic aminopenicillin i ka mālama ʻana i nā enterococcus UTI, ʻoiai inā loaʻa i nā mea hoʻokaʻawale kahi MIC i ʻoi aku ma mua o ka haʻihaʻi susceptibility.4,5

Ma muli o ka hoʻomaʻemaʻe ʻia ʻana o nā antibiotic AP ma o nā puʻupaʻa, hiki iā mākou ke hoʻokō i ka ʻoi aku ka kiʻekiʻe o ka ʻike ma ka mimi ma mua o ke kahe koko. Ua hiki i kahi noiʻi ke hōʻike i ka awelika o ka urine o 1100 μg/mL i hōʻiliʻili ʻia ma mua o 6 mau hola ma hope o hoʻokahi wale nō o ka amoxicillin waha 500 mg.

ʻO kekahi noiʻi ʻē aʻe i hoʻopaʻa ʻia i ka ampicillin-resistantenterococcus faecium(E. Faecium) hoʻokaʻawale ʻia ka mimi me nā MIC i hōʻike ʻia he 128 μg/mL (30%), 256 μg/mL (60%), a me 512 μg/mL (10%).4 Ke hoʻohana nei i ka ʻikepili mai kēia mau hoʻāʻo ʻana, kūpono ke ʻōlelo ʻana i nā ʻāpana AP hiki i ka nui o ka hoʻopaʻa ʻana i loko o ka ʻāpana mimi e mālama i nā maʻi he nui i hōʻike ʻia.

Ma kahi noiʻi ʻē aʻe, ua ʻike ʻia ka pale ʻana i ka ampicillinE. faeciumHe ʻokoʻa nā MIC o ka mimi, me ka MIC waena o 256 μg/mL5. ʻO 5 wale nō nā mea hoʻokaʻawale i loaʻa ka waiwai MIC> 1000 μg / mL, akā aia kēlā me kēia o kēia mau mea i loko o 1 dilution o 512 μg / mL.

Hōʻike nā lāʻau lapaʻau penicillin i ka pepehi ʻana i ka manawa a loaʻa kahi pane maikaʻi loa inā ʻoi aku ka lōʻihi o ka neʻe ʻana o ka mimi ma luna o ka MIC no ka liʻiliʻi o 50% o ka wā dose. mālamaEnterococcusnā ʻano, akā ʻaʻole kūʻē i ka ampicillinenterococcushoʻokaʻawale ʻia i nā UTI haʻahaʻa, ʻoiai ka lōʻihi o ke kau ʻia ʻana.

ʻO ka hoʻonaʻauao ʻana i nā mea kākau ʻōlelo kekahi ala e hiki ai iā mākou ke hoʻemi i ka nui o nā lāʻau antibiotic ākea ākea i hoʻohana ʻia no ka mālama ʻana i kēia mau maʻi, e like me linezolid a me daptomycin. ʻO kekahi ala ʻē aʻe, ʻo ia ka hoʻomohala ʻana i kahi protocol ma nā ʻoihana pākahi e kōkua i ke alakaʻi ʻana i nā mea kuhikuhi i ka kuhikuhi kuhikuhi kuhikuhi.

ʻO kekahi o nā ala maikaʻi loa e pale aku ai i kēia pilikia e hoʻomaka i ka microbiology lab. E hāʻawi mai nā wahi haʻihaʻi mimi iā mākou i ka ʻikepili hiki ke hilinaʻi ʻia; akā naʻe, ʻaʻole loaʻa kēia i kēia manawa.

Ua hoʻopau ka nui o nā haukapila i kā lākou hoʻāʻo maʻamauenterococcushoʻokaʻawale ʻia ka mimi a hōʻike i nā mea a pau i maʻa mau i nā aminopenicillins.6 Ua loiloi kekahi noiʻi i nā hopena lapaʻau ma waena o nā maʻi i mālama ʻia no ka VRE UTI me kahi lāʻau antibiotic AP i hoʻohālikelike ʻia me nā mea i mālama ʻia me ka lāʻau antibiotic non-beta-lactam.

I loko o kēia haʻawina, ua manaʻo ʻia ka maʻi AP ma nā hihia āpau, me ka nānā ʻole i ka maʻalahi o ka ampicillin. I loko o ka hui AP, ʻo ka mea maʻamau i koho ʻia no ka lāʻau definitive ʻo amoxicillin a ukali ʻia e intravenous ampicillin, ampicillin-sulbactam, a me amoxicillin-clavulanate.

I ka hui non-beta-lactam, ʻo ka mea maʻamau i koho ʻia no ka lāʻau definitive ʻo linezolid, a ukali ʻia e daptomycin a me fosfomycin. ʻO ka helu o ka lāʻau lapaʻau he 83.9% nā mea maʻi i ka hui AP a me 73.3% i ka hui non-beta-lactam.

Ua ʻike ʻia ka lāʻau lapaʻau lapaʻau me ka AP therapy ma 84% o nā hihia āpau a ma 86% o nā maʻi me nā ʻokoʻa ampicillin-resistant, ʻaʻohe ʻokoʻa helu helu ma waena o nā hopena no ka poʻe i mālama ʻia me nā non-β-lactams.