The Infectious Diseases Society of America parizvino inokurudzira amoxicillin uye ampicillin, aminopenicillin (AP) mishonga inorwisa mabhakitiriya, semishonga yesarudzo yekurapa.enterococcusUTIs.2 Kuwanda kwe ampicillin-resistant enterococcus kwave kuwedzera.

Kunyanya, chiitiko chevancomycin-resistantenterococci(VRE) yakada kupeta kaviri mumakore achangopfuura, uye 30% yekliniki enterococcal isolates inonzi inopikisa vancomycin.3 Kubva pane ikozvino Clinical and Laboratory Standards Institute standard,Enterococcusmarudzi ane mashoma inhibitory concentration (MIC) ≥ 16 μg/mL anoonekwa seampicillin-resistant.

Microbiology marabhoritari anoshandisa nzvimbo imwechete iyi zvisinei nenzvimbo yehutachiona. Pharmacokinetic, pharmacodynamics, uye kliniki yekuongorora data inotsigira kushandiswa kweaminopenicillin antibiotics mukurapa enterococcus UTIs, kunyange kana vakazviparadzanisa vane MIC inopfuura kudarika kukanganisa.4,5

Nekuti AP mishonga inorwisa mabhakitiriya inocheneswa kuburikidza neitsvo, tinokwanisa kuwana yakanyanya kuwanda muweti pane muropa. Imwe ongororo yakakwanisa kuratidza avhareji weti yekusangana kwe1100 μg/mL yakaunganidzwa kwemaawa matanhatu mushure meimwe domo remuromo amoxicillin 500 mg.

Imwe ongororo yakaongorora ampicillin-resistantenterococcus faecium(E. Faecium) weti inoparadzana neMICs yakashumwa ye128 μg/mL (30%), 256 μg/mL (60%), uye 512 μg/mL (10%).4 Kushandisa data kubva mumiedzo iyi, zvinonzwisisika kutaura kuti AP concentrations kusvika pakudzika kwakakwana muurinary tract kurapa zvirwere zvakawanda zvinoshumwa zvinoramba.

Mune imwe ongororo, zvakaonekwa kuti ampicillin-resistantE. faeciumweti yakazviparadzanisa yaive neMIC dzakasiyana, ine yepakati MIC ye256 μg/mL5. Zvishanu chete zvitsaurwa zvaive neMIC kukosha> 1000 μg/mL, asi imwe neimwe yezvitsaura izvi yaive mukati me1 dilution ye512 μg/mL.

Penicillin mishonga inorwisa mabhakitiriya inoratidzira kuuraya kunoenderana nenguva uye mhinduro yakakwana ichaitika chero bedzi kuiswa kweweti kuri pamusoro peMIC kweinenge 50% yenguva yekutora. kubataEnterococcusmarudzi, asiwo ampicillin-resistantenterococcusyakaparadzaniswa mune yakaderera UTIs, chero yakaderedzwa zvine musoro.

Kudzidzisa varayiri ndiyo imwe nzira yatinogona kuderedza huwandu hwemishonga inorwisa mabhakitiriya yakawanda inoshandiswa kurapa zvirwere izvi, zvakadai selinezolid uye daptomycin. Imwe nzira ndeyekugadzira protocol kumasangano ega ega kubatsira kutungamira vanyoreri kune inotungamirwa-inotungamirwa kurairwa.

Imwe yedzakanakisa nzira dzekurwisa dambudziko iri inotanga mu microbiology lab. Weti-chaiyo breakpoints yaizotipa yakavimbika susceptibility data; zvisinei, izvi hazviwanikwe zvakanyanya panguva ino.

Zvipatara zvakawanda zvakamisa ongororo yazvo yekuongororwaenterococcusurinary isolates uye inoshuma zvose sezvinowanzoitwa aminopenicillins.6 Imwe tsvakurudzo yakaongorora migumisiro yekurapa pakati pevarwere vanobatwa neVRE UTI neAP antibiotic kana vachienzaniswa nevaya vanorapwa ne-non-beta-lactam antibiotic.

Muchidzidzo ichi, kurapwa kweAP kwainzi kunoshanda mune zvese zviitiko, zvisinei nekusagadzikana kweampicillin. Mukati meboka reAP, mumiriri akanyanya kusarudzwa kuti anyatso kurapa aive amoxicillin achiteverwa neintravenous ampicillin, ampicillin-sulbactam, uye amoxicillin-clavulanate.

Muboka risiri-beta-lactam, mumiririri ainyanyozivikanwa akasarudzwa kuti arapwe kwakananga yaive linezolid, ichiteverwa nedaptomycin nefosfomycin. Chiyero chekurapa kwekiriniki chaive 83.9% varwere muboka reAP uye 73.3% muboka risiri-beta-lactam.

Kurapa kwechipatara neAP therapy kwakaonekwa mu84% yezviitiko zvose uye mu86% yevarwere vane ampicillin-resistant isolates, pasina mutsauko wenhamba wakaonekwa pakati pemigumisiro kune avo vanorapwa ne-non-β-lactam.