Umuryango w’indwara zandura muri Amerika muri iki gihe urasaba amoxicilline na ampisilline, antibiyotike ya aminopenicilline (AP), nk'imiti ihitamo kuvuraenterococcusUTIs.2 Indwara ya ampicilline irwanya enterococcus yagiye yiyongera.

By'umwihariko, indwara ya vancomycine irwanyaenterococci.Enterococcusamoko afite intumbero ntoya (MIC) ≥ 16 μg / mL afatwa nkurwanya ampisiline.

Laboratoire za Microbiology zikoresha aho zihurira hatitawe aho zanduye. Pharmacokinetic, pharmacodynamics, hamwe namakuru yikigereranyo cyamavuriro ashyigikira ikoreshwa rya antibiyotike ya aminopenicillin mu kuvura UTIs ya enterococcus, kabone niyo abigunga bafite MIC irenze aho byoroshye.4,5

Kubera ko antibiyotike ya AP isukurwa binyuze mu mpyiko, dushobora kugera cyane ku nkari kuruta mu maraso. Ubushakashatsi bumwe bwashoboye kwerekana impuzandengo yinkari zingana na 1100 μg / mL zegeranijwe mu masaha 6 nyuma yikinini kimwe cya amoxicilline yo mu kanwa 500 mg.

Ubundi bushakashatsi bwasesenguye ampisiline irwanyaenterococcus faecium(E. Faecium) inkari zitandukanya na MIC zavuzwe za 128 μg / mL (30%), 256 μg / mL (60%), na 512 μg / mL (10%). gera kumurongo uhagije mumitsi yinkari kugirango uvure indwara nyinshi zirwanya indwara.

Muyindi nyigo, byagaragaye ko irwanya ampisilineE. faeciuminkari zitandukanya zifite MIC zitandukanye, hamwe na MIC yo hagati ya 256 μg / mL5. 5 yonyine yonyine yari ifite agaciro ka MIC> 1000 μg / mL, ariko buri kimwekimwe cyose cyari muri 1 dilution ya 512 μg / mL.

Antibiyotike ya penisiline yerekana kwica biterwa nigihe kandi igisubizo cyiza kizabaho mugihe cyose inkari ziri hejuru ya MIC byibuze 50% byigihe cyo kunywa.5 Kubwibyo, dushobora gufata umwanzuro ushimishije ko imiti ivura antibiyotike ya AP itazakora neza gusa kuvuraEnterococcusamoko, ariko kandi irwanya ampisilineenterococcusyitaruye muri UTI yo hepfo, igihe cyose ikwiye.

Kwigisha abandikirana ni inzira imwe dushobora kugabanya ingano ya antibiyotike yagutse ikoreshwa mu kuvura izo ndwara, nka linezolide na daptomycine. Ubundi buryo ni ugutegura protocole mubigo byihariye kugirango ifashe kuyobora abayigana kugana umurongo ngenderwaho.

Bumwe mu buryo bwiza bwo kurwanya iki kibazo butangirira muri laboratoire ya microbiology. Ibice byihariye byinkari byaduha amakuru yizewe byoroshye; ariko, ibi ntibishoboka cyane muriki gihe.

Ibitaro byinshi byahagaritse kwipimisha bisanzweenterococcusinkari zitandukanya kandi zigatanga raporo zose nkizisanzwe zishobora kwibasirwa na aminopenicilline.6 Ubushakashatsi bumwe bwerekanye ibyavuye mu buvuzi hagati y’abarwayi bavuwe na VRE UTI hamwe na antibiotike ya AP ugereranije n’abavuwe na antibiyotike itari beta-lactam.

Muri ubu bushakashatsi, ubuvuzi bwa AP bwafatwaga nkigikorwa muri byose, hatitawe ku kwandura ampisilline. Mu itsinda rya AP, abakozi benshi batoranijwe kugirango bavurwe neza ni amoxicilline ikurikirwa na ampisilline yo mu nda, ampisilline-sulbactam, na amoxicillin-clavulanate.

Mu itsinda ritari beta-lactam, abakozi benshi batoranijwe kugirango bavurwe neza ni linezolid, hagakurikiraho daptomycine na fosfomycine. Igipimo cyo gukira kwa muganga cyari abarwayi 83.9% mu itsinda rya AP na 73.3% mu itsinda ritari beta-lactam.

Ubuvuzi bwa Clinical hamwe nubuvuzi bwa AP bwagaragaye kuri 84% mubibazo byose no kuri 86% byabarwayi bafite ampisiline irwanya indwara, nta tandukanyirizo ry’imibare ryagaragaye hagati y’ibisubizo ku bavuwe badafite β-lactam.